Childhood factors that predict persistence of severe asthma from late adolescence through early adulthood

Abstract

Most children start out with mild asthma but some may progress to have severe asthma. It is important to identify factors in childhood that might predict severe asthma in late adolescence through early adulthood. The Childhood Asthma Management Program (CAMP) is the largest and longest asthma clinical trial in 1041 children aged 5-12 years with mild to moderate asthma. We evaluated 682 CAMP participants who had analyzable data in late adolescence (at age 17-19) through early adulthood (age 21-23). Multinomial logistic regression analysis with backwards elimination was used to investigate clinical features, biomarkers, and lung function predictive of severe asthma (based on National Asthma Education and Prevention Program criteria). 34.8% and 22.1% had severe asthma in late adolescence and early adulthood, respectively; only 11% of the total 682 patients stayed severe. Pre-bronchodilator FEV1/FVC ratio at baseline and duration of asthma were associated with persistence of severe asthma from late adolescence to early adulthood. For every 5 point increase in FEV1/FVC ratio at baseline, the odds of a person remaining severe could be as low as 33% (change of 0.05, p=0.0008, odds ratio 0.67 to 0.90). For every year increase of asthma duration, the odds of a person remaining severe could be as high as 18%. (change of 1 year, p= 0.10, odds ratio 0.98-1.18). Lung function was the only significant childhood predictor of severe asthma from late adolescence through early adulthood. Interventions to preserve lung function early in childhood should be developed to prevent and reverse disease progression.