Mh. Grol et al., Risk factors for growth and decline of lung function in asthmatic individuals up to age 42 years - A 30-year follow-up study, AM J R CRIT, 160(6), 1999, pp. 1830-1837
Little is known about factors determining the outcome of childhood asthma.
The purpose of this longitudinal study was to assess the factors in childho
od that determine the level of FEV1 in early adulthood in asthmatic individ
uals, and to examine factors associated with decline in FEV1 during adultho
od. Between 1966 and 1969, 119 allergic asthmatic subjects aged 5 to 14 yr
were studied (Visit 1). Of these subjects, 101 (85%) were reinvestigated at
ages 22 to 32 yr (visit 2) and 32 to 42 yr (Visit 3). At the first survey
and during follow-up, a standardized questionnaire was used, serum total Ig
E and peripheral blood eosinophils were measured, and physical examination,
skin tests, lung function tests, and histamine challenge (provocative conc
entration causing a 10% decline in FEV1; PC10) tests were performed accordi
ng to the same protocol. Multiple linear regression analyses were performed
with FEV1 at Visit 2 and with the change of FEV1 from Visit 2 to Visit 3 a
s outcome variables. A low FEV1% predicted at Visit 1 and PC10 less than or
equal to 16 mg/ml at Visit 1 were significantly associated with a lower le
vel of FEV1 at Visit 2. Subjects who quit smoking and subjects who continue
d to use inhaled corticosteroids had a significantly smaller annual decline
in FEV1 from Visit 2 to Visit 3, adjusted for attained level of FEV1 at Vi
sit 2. In conclusion, bronchial hyperresponsiveness and a low level of lung
function in childhood are independent risk factors for a low level of FEV1
in early adulthood. A smaller decline in FEV1 after ages 22 to 32 yr occur
s in asthmatics who quit smoking and who continue to use inhaled corticoste
roids. Our data stress the importance of studying intervention strategies f
or asthma in young childhood and early adulthood in order to prevent or pos
tpone further lung function deficits.