Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Natural history of asthma

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


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".)


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].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Mar 28, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Guilbert T, Krawiec M. Natural history of asthma. Pediatr Clin North Am 2003; 50:523.
  2. Bisgaard H, Bønnelykke K. Long-term studies of the natural history of asthma in childhood. J Allergy Clin Immunol 2010; 126:187.
  3. Ernst P, Cai B, Blais L, Suissa S. The early course of newly diagnosed asthma. Am J Med 2002; 112:44.
  4. Bronnimann S, Burrows B. A prospective study of the natural history of asthma. Remission and relapse rates. Chest 1986; 90:480.
  5. Silverstein MD, Reed CE, O'Connell EJ, et al. Long-term survival of a cohort of community residents with asthma. N Engl J Med 1994; 331:1537.
  6. McFadden ER Jr. Natural history of chronic asthma and its long-term effects on pulmonary function. J Allergy Clin Immunol 2000; 105:S535.
  7. Morgan WJ, Stern DA, Sherrill DL, et al. Outcome of asthma and wheezing in the first 6 years of life: follow-up through adolescence. Am J Respir Crit Care Med 2005; 172:1253.
  8. Phelan PD, Robertson CF, Olinsky A. The Melbourne Asthma Study: 1964-1999. J Allergy Clin Immunol 2002; 109:189.
  9. Vonk JM, Postma DS, Boezen HM, et al. Childhood factors associated with asthma remission after 30 year follow up. Thorax 2004; 59:925.
  10. Matricardi PM, Illi S, Grüber C, et al. Wheezing in childhood: incidence, longitudinal patterns and factors predicting persistence. Eur Respir J 2008; 32:585.
  11. Stern DA, Morgan WJ, Halonen M, et al. Wheezing and bronchial hyper-responsiveness in early childhood as predictors of newly diagnosed asthma in early adulthood: a longitudinal birth-cohort study. Lancet 2008; 372:1058.
  12. Tager IB, Hanrahan JP, Tosteson TD, et al. Lung function, pre- and post-natal smoke exposure, and wheezing in the first year of life. Am Rev Respir Dis 1993; 147:811.
  13. Tse SM, Rifas-Shiman SL, Coull BA, et al. Sex-specific risk factors for childhood wheeze and longitudinal phenotypes of wheeze. J Allergy Clin Immunol 2016; 138:1561.
  14. Martinez FD, Wright AL, Taussig LM, et al. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med 1995; 332:133.
  15. Dodge R, Martinez FD, Cline MG, et al. Early childhood respiratory symptoms and the subsequent diagnosis of asthma. J Allergy Clin Immunol 1996; 98:48.
  16. Oswald H, Phelan PD, Lanigan A, et al. Outcome of childhood asthma in mid-adult life. BMJ 1994; 309:95.
  17. Horak E, Lanigan A, Roberts M, et al. Longitudinal study of childhood wheezy bronchitis and asthma: outcome at age 42. BMJ 2003; 326:422.
  18. Covar RA, Strunk R, Zeiger RS, et al. Predictors of remitting, periodic, and persistent childhood asthma. J Allergy Clin Immunol 2010; 125:359.
  19. Andersson M, Hedman L, Bjerg A, et al. Remission and persistence of asthma followed from 7 to 19 years of age. Pediatrics 2013; 132:e435.
  20. Perzanowski MS, Ronmark E, James HR, et al. Relevance of specific IgE antibody titer to the prevalence, severity, and persistence of asthma among 19-year-olds in northern Sweden. J Allergy Clin Immunol 2016; 138:1582.
  21. Chipps BE, Szefler SJ, Simons FE, et al. Demographic and clinical characteristics of children and adolescents with severe or difficult-to-treat asthma. J Allergy Clin Immunol 2007; 119:1156.
  22. Miller MK, Johnson C, Miller DP, et al. Severity assessment in asthma: An evolving concept. J Allergy Clin Immunol 2005; 116:990.
  23. Fitzpatrick AM, Teague WG. Severe Asthma in Children: Insights from the National Heart, Lung, and Blood Institute's Severe Asthma Research Program. Pediatr Allergy Immunol Pulmonol 2010; 23:131.
  24. Dolan CM, Fraher KE, Bleecker ER, et al. Design and baseline characteristics of the epidemiology and natural history of asthma: Outcomes and Treatment Regimens (TENOR) study: a large cohort of patients with severe or difficult-to-treat asthma. Ann Allergy Asthma Immunol 2004; 92:32.
  25. Weiss ST, Tosteson TD, Segal MR, et al. Effects of asthma on pulmonary function in children. A longitudinal population-based study. Am Rev Respir Dis 1992; 145:58.
  26. Strunk RC, Weiss ST, Yates KP, et al. Mild to moderate asthma affects lung growth in children and adolescents. J Allergy Clin Immunol 2006; 118:1040.
  27. McGeachie MJ, Yates KP, Zhou X, et al. Patterns of Growth and Decline in Lung Function in Persistent Childhood Asthma. N Engl J Med 2016; 374:1842.
  28. Zeiger RS, Dawson C, Weiss S. Relationships between duration of asthma and asthma severity among children in the Childhood Asthma Management Program (CAMP). J Allergy Clin Immunol 1999; 103:376.
  29. Tai A, Tran H, Roberts M, et al. Outcomes of childhood asthma to the age of 50 years. J Allergy Clin Immunol 2014; 133:1572.
  30. Martin AJ, Landau LI, Phelan PD. Lung function in young adults who had asthma in childhood. Am Rev Respir Dis 1980; 122:609.
  31. Kelly WJ, Hudson I, Raven J, et al. Childhood asthma and adult lung function. Am Rev Respir Dis 1988; 138:26.
  32. Jenkins MA, Hopper JL, Bowes G, et al. Factors in childhood as predictors of asthma in adult life. BMJ 1994; 309:90.
  33. Godden DJ, Ross S, Abdalla M, et al. Outcome of wheeze in childhood. Symptoms and pulmonary function 25 years later. Am J Respir Crit Care Med 1994; 149:106.
  34. Dawson B, Illsley R, Horobin G, Mitchell R. A survey of childhood asthma in Aberdeen. Lancet 1969; 1:827.
  35. Edwards CA, Osman LM, Godden DJ, Douglas JG. Wheezy bronchitis in childhood: a distinct clinical entity with lifelong significance? Chest 2003; 124:18.
  36. Tantisira KG, Colvin R, Tonascia J, et al. Airway responsiveness in mild to moderate childhood asthma: sex influences on the natural history. Am J Respir Crit Care Med 2008; 178:325.
  37. Triebner K, Johannessen A, Puggini L, et al. Menopause as a predictor of new-onset asthma: A longitudinal Northern European population study. J Allergy Clin Immunol 2016; 137:50.
  38. Settipane GA, Greisner WA 3rd, Settipane RJ. Natural history of asthma: a 23-year followup of college students. Ann Allergy Asthma Immunol 2000; 84:499.
  39. Sears MR. Consequences of long-term inflammation. The natural history of asthma. Clin Chest Med 2000; 21:315.
  40. Slavin RG, Haselkorn T, Lee JH, et al. Asthma in older adults: observations from the epidemiology and natural history of asthma: outcomes and treatment regimens (TENOR) study. Ann Allergy Asthma Immunol 2006; 96:406.
  41. Lange P, Parner J, Vestbo J, et al. A 15-year follow-up study of ventilatory function in adults with asthma. N Engl J Med 1998; 339:1194.
  42. Sears MR. Lung function decline in asthma. Eur Respir J 2007; 30:411.
  43. Ulrik CS, Lange P. Decline of lung function in adults with bronchial asthma. Am J Respir Crit Care Med 1994; 150:629.
  44. Burrows B, Lebowitz MD, Barbee RA, Cline MG. Findings before diagnoses of asthma among the elderly in a longitudinal study of a general population sample. J Allergy Clin Immunol 1991; 88:870.