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Natural history of asthma

Authors
Augusto A Litonjua, MD
Scott T Weiss, MD, MS
Section Editors
Peter J Barnes, DM, DSc, FRCP, FRS
Robert A Wood, MD
Deputy Editor
Helen Hollingsworth, MD

INTRODUCTION

The natural history of asthma is variable and difficult to predict for a particular individual [1,2]. Children with asthma experience complete remission more frequently than adults; however, progression to severe disease is unusual in all age groups [3,4]. Although deaths do occur from asthma, they are rare, and asthma in the absence of other comorbid disease does not typically affect life expectancy [5,6].

The natural history of asthma from infancy to adulthood will be discussed here. The diagnosis and management of asthma, the impact of inhaled glucocorticoid treatment on the progression of childhood asthma, and the role of risk factors are discussed separately. (See "Asthma in children younger than 12 years: Initial evaluation and diagnosis" and "Diagnosis of asthma in adolescents and adults" and "Asthma in children younger than 12 years: Treatment of persistent asthma with controller medications", section on 'Inhaled glucocorticoids' and "An overview of asthma management" and "Risk factors for asthma".)

INFANTS AND CHILDREN

Many infants wheeze early in life, but three of four school-aged children outgrow asthma by adulthood [1]. On the other hand, the majority of chronic asthma begins in the first six years of life [2,7,8]. (See "Evaluation of wheezing in infants and children".)

Wheezing during the first six years — Several studies examining the natural history of wheezing and asthma in the first six years of life support the concept that there are at least two groups of children who have wheeze and asthma-like symptoms at an early age [9-11]. One group tends to have intermittent symptoms, usually in relation to viral illnesses, and to outgrow the symptoms as the children get older. The other group, which tends to have later-onset and more persistent symptoms, is characterized by atopy, a positive family history of asthma, and an increased risk for asthma later in life. Despite identification of risk factors, prospective identification of an individual's future asthma experience is not possible [2]. (See "Risk factors for asthma".)

One possible explanation for transient wheezing in infants is that infants have smaller airways, which predispose them to wheezing in the face of viral infections or other insults. This possibility is supported by the observation that infants who develop lower respiratory tract illnesses in the first year of life had reduced lung function prior to developing any symptoms [12].

            
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Literature review current through: Nov 2017. | This topic last updated: Mar 28, 2017.
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