Asthma that manifests in early adulthood has its origins in early childhood, according to an article released on September 19, 2008 in The Lancet.
To investigate the origins of adult-onset asthma, Dr Debra Stern and Professor Fernando D Martinez, Arizona Respiratory Center, Tucson, Arizona, USA, and colleagues examined the Tucson Children’s Respiratory Study, a cohort beginning in the early 1980s. Of the 1,246 babies enrolled in the study, 849 completed follow-up for 22 years. Evaluation was performed regularly via questionnaire, an allergy prick test for various common allergens, lung capacity. Patients were classified based on asthma status between the ages of 0 and 16 years, then further for asthma status at age 22.
At 22 years of age, 181 cases of active asthma were reported. Of these, 27% were newly diagnosed, meaning that they were not diagnosed with asthma by age 16 but had shown signs of the disease by age 22. This group of patients was overwhelmingly female (71%). Men had twice the chance of asthma remission by the age of 22.
Several factors were associated with chronic asthma, in which the subject showed asthma symptoms before age 16 and in the follow-up period to age 22. These included the onset of wheezing by age 6, persistent wheezing in early life, sensitization to Alternaria alernata (an indoor allergen that has been associated with asthma), low airway function at age 6, and bronchial hyper-responsiveness at age six. Newly diagnosed asthma at age 22 years was associated with several factors. These included bronchial hyper-responsiveness at age 6, low airway function at six, wheezing onset at 6, and persisten wheezing.
In conclusion, the authors note the major associated risk factors for asthma in early adulthood: “In over 70% of people with current asthma and 63% of those with newly diagnosed asthma at age 22 years, episodes of wheezing had happened in the first three years of life or were reported by parents at age six years…Our findings support our previous proposition that most forms of asthma have their origins in early life, but we now extend that proposition to asthma diagnosed in early adult life.”
Dr Susanne Lau, Charité University Medicine, Berlin, Germany, contributed an accompanying comment which implies the need for further research regarding prevention methods. “These findings identify a population at risk of chronic obstructive airway disease in early adulthood, and they already showed a predisposition during preschool years. Whether therapeutic approaches at early preschool age can affect progression of the disease is yet to be established.”
Wheezing and bronchial hyper-responsiveness in early childhood as predictors of newly diagnosed asthma in early adulthood: a longitudinal birth-cohort study
Debra A Stern, Wayne J Morgan, Marilyn Halonen, Anne L Wright, Fernando D Martinez
Lancet 2008; 372: 1058-64
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Written by Anna Sophia McKenney