Asthma Remission From Childhood to Young Adulthood-A Population-Based Cohort Study.

Background

The long-term prognosis of childhood asthma remains uncertain. We aimed to (1) assess the prevalence of asthma remission from childhood to young adulthood, (2) identify associated factors, and (3) evaluate whether symptom-based remission was related to objective markers of inflammation and lung function.

Materials And Methods

We analyzed data from 2698 participants in the Swedish population-based BAMSE birth cohort, followed up to age 24 years with questionnaires and clinical examinations. Symptom-based remission was defined as absence of asthma symptoms and medication in the preceding year. Clinical remission also required no hospital visits and optimization of lung function (postbronchodilator forced expiratory volume in 1 s ≥ 80%). Complete remission required normal eosinophil counts (< 0.3 × 109/L) and fractional exhaled nitric oxide levels (< 40 ppb).

Results

Among 257 participants with asthma at age 8 years, 39% achieved symptom-based remission, 29% clinical remission, and 18% complete remission at age 24 years. Male sex increased the likelihood of symptom-based remission (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.3-4.5), whereas food sensitization (OR 0.3, 95% CI 0.3-0.6) and overweight/obesity (OR 0.4, 95% CI 0.2-0.9) decreased it. Among individuals in symptom-based remission, 27% displayed abnormal results in at least one objective marker.

Conclusions

Four of 10 participants with asthma in childhood achieved symptom-based remission by young adulthood, but rates declined when stricter, objective definitions were applied. A substantial subset of individuals with symptom-based remission still showed signs of type two inflammation or reduced lung function, indicating that absence of symptoms does not necessarily reflect complete disease resolution.