A L L E R G Y A N D A S T H M A C O N N E C T I O N —from the American Academy of Allergy, Asthma and Immunology

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Will My ChildOutgrow Asthma?Kathleen Sheerin, MD, FAAAAI

Asthma is the most common chronic disease ofchildhood, affecting more than 5 millionAmerican children. In 50% to 80% of childrenwith asthma, the disease starts before the age of 5.

When a physician tells parents that their childhas asthma, one of the first questions the parentsare likely to ask is “Will my child outgrow hisasthma?” The answer is a resounding “maybe!”

Regardless of whether or not a child may out-grow asthma in the future, it is important todiagnose and treat the condition appropriately. Insome cases, the hope that the child will outgrowasthma leads to reluctance among some physi-cians and patients to call asthma what it is. Thishope also may delay the start of controller med-ications, such as inhaled corticosteroids. Forchronic asthma, these medications are importantto help control the inflammatory component ofthe disease early in life. It would be helpful tophysicians and parents to have a better under-standing of how a child’s asthma may progress ashe or she grows. Researchers are looking at factorsthat can help physicians distinguish between thechild who has asthma early in life but will neverwheeze or cough again, verses the child who willgo on to have persistent asthma.

Dr. Fernando Martinez and his colleagues inTucson, Ariz., have looked at a large number ofyoung children with asthma. Their research showsthree patterns of disease that occur:

1. Children who wheeze before age three butare no longer wheezing by age six

2. Children who wheeze before age three andcontinue to wheeze at age six

3. Children who have onset of asthma after agethree

The children who start to wheeze early inchildhood, and continue to wheeze throughoutchildhood tend to be those with allergies, espe-cially atopic dermatitis (eczema). They also tendto be children with mothers who have asthma.These children start out with normal lung func-tion and end up with abnormal lung function.The children who seem to “outgrow” their asth-ma tend to be those who have multiple siblingsor attend day care (suggesting they have had sig-nificant exposure to infections early in life). Theyalso tend to have mothers who smoke and havedecreased lung function from birth. Overall,Martinez found that approximately 60% of chil-dren who wheeze only with viral respiratoryinfections early in life do not continue to wheezebeyond age 6.

There are growing volumes of data that arestarting to clarify patterns and characteristics thatmay help us predict which child will have persis-tent asthma:• More boys than girls have asthma before

puberty.• Atopy (the allergic state) is strongly associated

with persistent wheezing. Babies with bad atopic

Kathleen Sheerin, MD,FAAAAI, is an aller-gist/immunologist inAtlanta, Ga. She is thevice chair of the AAAAIPublic EducationCommittee.

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dermatitis (eczema) and positive allergy skin testshave a greater risk of persistent asthma.

• Egg allergy may be a strong predictor of futurepersistent asthma.

• If a child has bronchiolitis (RSV infection) ormultiple episodes of croup in early childhood,their chances of having persistent asthmaincrease significantly.

• There is evidence linking parental smoking withpersistent asthma.

• Wheezing tends to abate in patients with lesssevere wheezing/asthma during the early years.If asthma is severe at the onset, this child seemsto be at increased risk of more severe persistentasthma.Most studies show that as many as 50% of

adults who report having asthma in childhoodare no longer symptomatic. Have they out-grown their asthma, or are their symptoms onlyin remission? Are these patients continuing tohave ongoing smoldering inflammation in thelungs but without the outward symptoms ofasthma?

StatisticsAsthma affects more than 4.8 million children under theage of 18.

Asthma rates in children under the age of 5 haveincreased more than 160% from 1980-1994.

More than 14 million school days are missed annuallybecause of asthma.

Asthma is 26% more prevalent in African American chil-dren than in white children.

Approximately 40% of children who have asthmatic par-ents will develop asthma.

In 1999, there were over 190,000 asthma hospitaliza-tions for children under age 15.

Sixty percent of people with asthma suffer specificallyfrom allergic asthma.

The prevalence of asthma increased 75% from 1980-1994.

TermsAirway obstruction: A narrowing, clogging, or blockingof the airways that carry oxygen to the lungs.

Allergen: A foreign substance that leads to allergies bytriggering an immune response.

Allergist: A physician who has completed medicalschool and post graduate training sufficient to qualify asa pediatrician or an internist and who has completed atleast a 2-year fellowship in the subspecialty ofallergy/immunology.

Allergy: A reaction of the immune system of an allergicperson to substances, which are harmless to mostpeople.

Asthma: A chronic, inflammatory lung disease charac-terized by recurrent breathing problems. Episodes ofasthma can be triggered by allergens, infection, exer-cise, cold air and other factors.

Inflammation: Redness, swelling, heat, and pain inbody tissue caused by an infection or a chemical orphysical injury. It is a characteristic of allergic reactionsin the nose, eyes, lungs, and skin.

Respiratory system: The group of organs responsiblefor carrying oxygen from the air to the bloodstream andfor expelling the waste product carbon dioxide.

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Some studies have shown patients who seem-ingly have outgrown their asthma actually contin-ue to have ongoing inflammation without anyobvious asthma symptoms. Under the right cir-cumstances, this inflammation intensifies and thepatient again becomes symptomatic with cough,wheeze, chest tightness, and shortness of breath.

Several long-term studies following patientswith childhood asthma into adulthood havefound relapses of asthma as the years go by.Research is continuing to identify markers ofinflammation that could help us to identify thosechildren who will have persistent asthma asadults, whether or not they may have had a peri-od of remission at some point. These markersmay help us to target these children with aggres-sive early intervention in an effort to prevent theprogression of the disease.

Although the answer to the question, “Willmy child outgrow asthma?” is a somewhat com-plicated one, the answer to the most importantquestions, “Can my child’s asthma be con-trolled?” and “Can my child lead a normalactive life?” is a resounding “YES!” There aresafe, effective, and easy-to-use medications thatcan control asthma in childhood. Most asthmaexperts treat children with inhaled cortico-steroid medication as early as possible. There areseveral ongoing studies of toddlers with asthmathat, in the next 2 to 3 years, should give usdefinitive answers about the longer-term out-comes of treating their asthma early and aggres-sively with inhaled corticosteroids.

doi:10.1067/S1088-0712(03)00108-0

The AAAAI is the largest professional medical specialty organization in the United States representing aller-gists, asthma specialists, clinical immunologists, allied health professionals, and others with a special interestin the research and treatment of allergic disease. Established in 1943, the Academy has more than 6000members in the United States, Canada, and 60 other countries. For more information, visit www.aaaai.org.

ResourcesFor PatientsThe website of the American Academy of Allergy, Asthma and Immunology (www.aaaai.org) is a strong resource for patients and healthcare providers looking for information on asthma and other allergic diseases. For more information on childhood asthma, check out thefollowing in the Patients and Consumers section of the website:

• Tips to Remember brochures on Childhood Asthma, the Role of the Allergist/Immunologist, Allergy and Asthma Medications, and Asthma Triggers and Management. (Available in English or Spanish.)

• Children’s book All About Asthma.• Fast Facts on Asthma.• Easy Reader Sheets on Asthma. (Available in English or Spanish.)• ADVOCATE patient newsletter.

For Health Care ProvidersPediatric Asthma: Promoting Best Practice Guidelines for Managing Asthma in Children is a comprehensivepublication for diagnosing and managing asthma. It was developed in partnership with the National AsthmaEducation and Prevention Program (NAEPP).The 140-page publication is a resource for family practice physicians, pediatricians, nurse practitioners,school nurses, and others who treat children with asthma. It provides national standards for diagnosing andmanaging asthma, as well as patient education information.To view the publication online, visit www.aaaai.org. Or, to order a copy of the publication for $15, contact:Erin Brunell, AAAAI Executive Office, 611 East Wells St., Milwaukee, WI, 53202; phone: (414) 272-6071; fax: (414) 272-6070;or email: info@aaaai.org.

The Allergy Report, a three-volume set providing guidance on the clinical management of allergic disorders, examines the barriers toeffective care and addresses future research needs.It was written by a 25-member task force that included representatives from the AAAAI, the American Medical Association, the NationalInstitute of Allergy and Infectious Diseases, and other national health organizations. It is available in English or Spanish.To view The Allergy Report online, visit www.theallergyreport.org. Copies of the report can be ordered on the website or by calling1-800-822-2762.