Natural history of asthma
- Augusto A Litonjua, MD
Augusto A Litonjua, MD
- Associate Professor of Medicine
- Harvard Medical School
- Scott T Weiss, MD, MS
Scott T Weiss, MD, MS
- Professor of Medicine
- Harvard Medical School
- Section Editors
- Peter J Barnes, DM, DSc, FRCP, FRS
Peter J Barnes, DM, DSc, FRCP, FRS
- Editor-in-Chief — Pulmonary and Critical Care Medicine
- Section Editor — Asthma
- Professor of Medicine
- National Heart and Lung Institute, Imperial College, London
- Robert A Wood, MD
Robert A Wood, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Pediatric Allergy
- Professor of Pediatrics
- Johns Hopkins University School of Medicine
The natural history of asthma is not well described. The relatively few cohort studies that initially examined this issue from childhood to early adulthood contained methodologic problems pertaining to subject selection (most were hospital or clinic based) and design (many were retrospective, did not incorporate a physiologic test for airway reactivity, and some did not examine the question of atopy) . Within the past few years, however, more data have become available from ongoing, prospective studies [2,3].
Children experience complete remission more frequently than adults; however, progression to severe disease is unusual in all age groups [4,5]. Although deaths do occur from asthma, asthma in the absence of other comorbid disease does not typically affect life expectancy [6,7].
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: Treatment of persistent asthma with controller medications" and "Risk factors for asthma" and "An overview of asthma management" and "Diagnosis of asthma in adolescents and adults".)
INFANTS AND CHILDREN
Many infants wheeze early in life. Those who develop wheezing with lower respiratory tract illnesses have reduced lung function prior to developing any symptoms . They may, for example, have smaller airways, which predispose them to wheezing in the face of viral infections or other insults. It is not clear which factors determine the development of asthma later in life, although some possible risk factors have been identified. (See "Approach to wheezing in infants and children" and "Wheezing illnesses other than asthma in children".)
Wheezing during the first six years — Several studies have examined the natural history of wheezing and asthma in the first six years of life.
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