A recent publication out of Norway highlighted through a 60 year follow-up, the prevalence of adults who continue to have asthma following a severe asthma diagnosis during childhood.
The authors presented the study question: In a 60-year follow up study, what are the differences in characteristics between adults with persistent asthma and those with asthma remission after severe childhood asthma?
Of the 232 (114 female/ 118 male) participants assessed in the study, 208 (88%) continued to need support of their asthma symptoms some 60 years on, only 24 participants no longer had symptoms or required treatment in the past 12 months.
Study participants underwent the ‘gold standard’ – Bronchial Provocation (Mannitol) Test as well as typical pre-post spirometry to assess bronchodilator responsiveness. Fractional expired Nitric Oxide was also tested along with a blood test to determine inflammatory markers.
Quick definition guide on airway function:
- FVC – Exhaled volume you can squeeze out, measured in litres
- FEV1 – How quickly you can empty your lungs in the first second, measured in litres
Statistically, airflow (FEV1) measured through spirometry was significantly lower in patients with continuing asthma presence (2.53L) compared to those without asthma (3.00L). Furthermore, inflammation (as a measure of Plasma IgE) was significantly increased as well.
Interestingly, of the 24 patients not taking medication or symptomatic, 4 still had a significant response to a bronchodilator and 5 had a positive bronchial provocation test, questioning correct management strategies and self-identification of clinical symptoms.
It appears that the greater severity of asthma as a child, the higher likelihood of asthma continuing into adulthood. The study outlined above compares to similar findings from Melbourne, Australia, where 10% of patients no longer experienced asthma symptoms. In milder cases of asthma during childhood and conversely to the data above, Tasmanian studies showed 2/3 of study participants no longer experienced symptoms with more recent data depicting, 87%.
To conclude, asthma presentation can change over time and symptoms may become less severe or completely disappear. However, underlying pathology may remain present and be objectively evident in the instance of reversible airways or a positive bronchial provocation test.
The Wesley Lung Function Lab performs all three of the breathing assessments utilised in the above study. If you have concerns for yourself or someone you know, upon discussion – a referral can be obtained from your local GP to perform a;
- Spirometry Test (pre-post bronchodilator) – to measure airway function and reversibility
- FeNO – to measure inflammatory biomarkers within the upper airways
- Bronchial Provocation test (Mannitol) – For a clearer definition on asthma presence
References:
Savran, O., Bonnelykke K., Suppli Ulrik, C. (2024). Characteristics of adults with severe asthma in childhood, A 60-year follow-up study. CHEST. Vol 166 #4, p676-684.
