Adult asthma severity in individuals with a history of childhood asthma

Background: Childhood asthma can have a range of outcomes in adulthood. Objective: To identify clinical features and exposures associated with persistence and severity of childhood asthma in adulthood. Methods: Eighty-five of 121 subjects previously enrolled in a study of immunotherapy for childhood allergic asthma (age 5-12 years) were re-evaluated with allergy skin testing, spirometry, and interviews about asthma symptoms and medications. These young adults (age 17-30 years; 74% male) all had moderate to severe childhood asthma. Adult asthma severity was scored by using a modified version of National Heart, Lung, and Blood Institute severity categories. Results: Thirteen (15.3%) of 85 adult subjects were in remission despite persistent childhood asthma. Another 19 subjects (22.4%) had only intermittent asthma. The remaining 53 had persistent asthma, of whom 12 (14.1%) had mild asthma, 25 (29.4%) had moderate asthma, and 16 (18.8%) had severe asthma. Subjects in remission, compared with subjects with intermittent or persistent asthma, had lower total serum IgE in childhood (412 ng/mL vs 1136 ng/mL vs 968 ng/ml.; P =.02) and fewer positive allergy skin tests (7 vs 9 vs 10 from panel of 18; P =.02). Subjects in remission also had milder childhood asthma, indicated by lower average daily medication usage scores (1.6 vs 3.5 vs 4.4; P =.005) and lower percentage of days on inhaled corticosteroids (13.7% vs 24.7% vs 40.9%; P =.008). No significant association was found between current asthma severity and childhood immunotherapy (P =.46). Conclusion: The prognosis of childhood allergic asthma in adulthood is largely determined early in life. The degree of atopy appears to be a critical determinant of asthma persistence.