FACTORS IN CHILDHOOD AS PREDICTORS OF ASTHMA IN ADULT LIFE

Objective-To determine which factors measured in childhood predict ast hma in adult life. Design-Prospective study over 25 years of a birth c ohort initially studied at the age of 7. Setting-Tasmania, Australia. Subjects-1494 men and women surveyed in 1991-3 when aged 29 to 32 (75% of a random stratified sample from the 1968 Tasmanian asthma survey o f children born in 1961 and at school in Tasmania). Main outcome measu res-Self reported asthma or wheezy breathing in the previous 12 months (current asthma). Result-Of the subjects with asthma or wheezy breath ing by the age of 7, as reported by their parents 25.6% (190/741) repo rted current asthma as an adult compared with 10.8% (81/753) of subjec ts without parent reported childhood asthma (P<0.001). Factors measure d at the age of 7 that independently predicted current asthma as an ad ult were being female (odds ratio 1.57; 95% confidence interval 1.19 t o 2.08); having a history of eczema (1.45; 1.04 to 2.03); having a low mild forced expiratory flow rate (interquartile odds ratio 1.40; 1.15 to 1.71); having a mother or father with a history of asthma (1.74 (1 .23 to 2.47) and 1.68 (1.18 to 2.38) respectively); and having childho od asthma (1.59; 1.10 to 2.29) and, if so, having the first attack aft er the age of 2 (1.66; 1.17 to 2.36) or having had more than 10 attack s (1.70; 1.17 to 2.48). Conclusion-Children with asthma reported by th eir parents in 1968 were more likely than not to be free of symptoms a s adults. The subjects who had more severe asthma (especially if it de veloped after the age of 2 and was associated with reduced expiratory flow), were female, or had parents who had asthma were at an increased risk of having asthma as an adult. These findings have implications f or the treatment and prognosis of childhood asthma, targeting preventi ve and educational strategies, and understanding the onset of asthma i n adult life.