PULMONARY FUNCTIONS IN BRONCHIAL-ASTHMA F ROM EARLY-CHILDHOOD TO SCHOOL-AGE

Background and Methods: To assess clinical course and development of p ulmonary function in asthma from early childhood to school-age a follo w-up study was conducted in 100 schoolchildren (69 m, 31 f, mean age 9 .1 y) diagnosed to have asthma between 6 months and 3 years of age. 75 children were re-examined at the out-patient clinic, including pulmon ary function tests and a cold air challenge; for the remaining 25 we r eceived a detailed questionnaire. Results: Five to 10 years after init ial diagnosis only 27 % of the patients were clinically free of asthma tic symptoms; in 45 % symptoms had become less frequent, unchanged in 24 % and more severe in 4 %. Of 75 children only 11 (15 %) had a compl etely normal lung function at follow-up: Hyperinflation was observed i n 35 %, central airway obstruction in 59 % and small airway obstructio n in 52 %, Forty-seven children (63 %) showed either evidence of bronc hial hyperresponsiveness after cold air challenge or airways obstructi on (with baseline FEV1 < 70 % and/or MEF50 < 50 % predicted), such tha t a provocation test could not be performed. Of all symptomatic childr en, only 34% used inhalation treatment daily, and in only 28 % the inh alation regime was sufficient according to international consensus sta tements. Conclusion: We conclude that despite early diagnosis of asthm a in infancy and appropriate treatment plan the majority of children r emain symptomatic, This may at least partly be explained by insufficie nt treatment compliance, Education programs for patients and parents a re urgently needed.