Severe asthma during childhood and adolescence: A longitudinal study

Kristie R. Ross, Ritika Gupta, Mark D. DeBoer, Joe Zein, Brenda R. Phillips, David T. Mauger, Chun Li, Ross E. Myers, Wanda Phipatanakul, Anne M. Fitzpatrick, Ngoc P. Ly, Leonard B. Bacharier, Daniel J. Jackson, Juan C. Celedón, Allyson Larkin, Elliot Israel, Bruce Levy, John V. Fahy, Mario Castro, Eugene R. BleeckerDeborah Meyers, Wendy C. Moore, Sally E. Wenzel, Nizar N. Jarjour, Serpil C. Erzurum, W. Gerald Teague, Benjamin Gaston

Research output: Contribution to journalArticle

Abstract

Background: Morbidity and mortality associated with childhood asthma are driven disproportionately by children with severe asthma. However, it is not known from longitudinal studies whether children outgrow severe asthma. Objective: We sought to study prospectively whether well-characterized children with severe asthma outgrow their asthma during adolescence. Methods: Children with asthma were assessed at baseline with detailed questionnaires, allergy tests, and lung function tests and were reassessed annually for 3 years. The population was enriched for children with severe asthma, as assessed by the American Thoracic Society/European Respiratory Society guidelines, and subject classification was reassessed annually. Results: At baseline, 111 (59%) children had severe asthma. Year to year, there was a decrease in the proportion meeting the criteria for severe asthma. After 3 years, only 30% of subjects met the criteria for severe asthma (P <.001 compared with enrollment). Subjects experienced improvements in most indices of severity, including symptom scores, exacerbations, and controller medication requirements, but not lung function. Surprisingly, boys and girls were equally likely to has resolved asthma (33% vs 29%). The odds ratio in favor of resolution of severe asthma was 2.75 (95% CI, 1.02-7.43) for those with a peripheral eosinophil count of greater than 436 cells/μL. Conclusions: In longitudinal analysis of this well-characterized cohort, half of the children with severe asthma no longer had severe asthma after 3 years; there was a stepwise decrease in the proportion meeting severe asthma criteria. Surprisingly, asthma severity decreased equally in male and female subjects. Peripheral eosinophilia predicted resolution. These data will be important for planning clinical trials in this population.

Original languageEnglish (US)
Pages (from-to)140-146.e9
JournalJournal of Allergy and Clinical Immunology
Volume145
Issue number1
DOIs
StatePublished - Jan 2020

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Longitudinal Studies
Asthma
Respiratory Function Tests
Eosinophilia
Eosinophils
Population
Hypersensitivity
Odds Ratio
Clinical Trials
Guidelines

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology

Cite this

Ross, K. R., Gupta, R., DeBoer, M. D., Zein, J., Phillips, B. R., Mauger, D. T., ... Gaston, B. (2020). Severe asthma during childhood and adolescence: A longitudinal study. Journal of Allergy and Clinical Immunology, 145(1), 140-146.e9. https://doi.org/10.1016/j.jaci.2019.09.030
Ross, Kristie R. ; Gupta, Ritika ; DeBoer, Mark D. ; Zein, Joe ; Phillips, Brenda R. ; Mauger, David T. ; Li, Chun ; Myers, Ross E. ; Phipatanakul, Wanda ; Fitzpatrick, Anne M. ; Ly, Ngoc P. ; Bacharier, Leonard B. ; Jackson, Daniel J. ; Celedón, Juan C. ; Larkin, Allyson ; Israel, Elliot ; Levy, Bruce ; Fahy, John V. ; Castro, Mario ; Bleecker, Eugene R. ; Meyers, Deborah ; Moore, Wendy C. ; Wenzel, Sally E. ; Jarjour, Nizar N. ; Erzurum, Serpil C. ; Teague, W. Gerald ; Gaston, Benjamin. / Severe asthma during childhood and adolescence : A longitudinal study. In: Journal of Allergy and Clinical Immunology. 2020 ; Vol. 145, No. 1. pp. 140-146.e9.
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Ross, KR, Gupta, R, DeBoer, MD, Zein, J, Phillips, BR, Mauger, DT, Li, C, Myers, RE, Phipatanakul, W, Fitzpatrick, AM, Ly, NP, Bacharier, LB, Jackson, DJ, Celedón, JC, Larkin, A, Israel, E, Levy, B, Fahy, JV, Castro, M, Bleecker, ER, Meyers, D, Moore, WC, Wenzel, SE, Jarjour, NN, Erzurum, SC, Teague, WG & Gaston, B 2020, 'Severe asthma during childhood and adolescence: A longitudinal study', Journal of Allergy and Clinical Immunology, vol. 145, no. 1, pp. 140-146.e9. https://doi.org/10.1016/j.jaci.2019.09.030

Severe asthma during childhood and adolescence : A longitudinal study. / Ross, Kristie R.; Gupta, Ritika; DeBoer, Mark D.; Zein, Joe; Phillips, Brenda R.; Mauger, David T.; Li, Chun; Myers, Ross E.; Phipatanakul, Wanda; Fitzpatrick, Anne M.; Ly, Ngoc P.; Bacharier, Leonard B.; Jackson, Daniel J.; Celedón, Juan C.; Larkin, Allyson; Israel, Elliot; Levy, Bruce; Fahy, John V.; Castro, Mario; Bleecker, Eugene R.; Meyers, Deborah; Moore, Wendy C.; Wenzel, Sally E.; Jarjour, Nizar N.; Erzurum, Serpil C.; Teague, W. Gerald; Gaston, Benjamin.

In: Journal of Allergy and Clinical Immunology, Vol. 145, No. 1, 01.2020, p. 140-146.e9.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Severe asthma during childhood and adolescence

T2 - A longitudinal study

AU - Ross, Kristie R.

AU - Gupta, Ritika

AU - DeBoer, Mark D.

AU - Zein, Joe

AU - Phillips, Brenda R.

AU - Mauger, David T.

AU - Li, Chun

AU - Myers, Ross E.

AU - Phipatanakul, Wanda

AU - Fitzpatrick, Anne M.

AU - Ly, Ngoc P.

AU - Bacharier, Leonard B.

AU - Jackson, Daniel J.

AU - Celedón, Juan C.

AU - Larkin, Allyson

AU - Israel, Elliot

AU - Levy, Bruce

AU - Fahy, John V.

AU - Castro, Mario

AU - Bleecker, Eugene R.

AU - Meyers, Deborah

AU - Moore, Wendy C.

AU - Wenzel, Sally E.

AU - Jarjour, Nizar N.

AU - Erzurum, Serpil C.

AU - Teague, W. Gerald

AU - Gaston, Benjamin

PY - 2020/1

Y1 - 2020/1

N2 - Background: Morbidity and mortality associated with childhood asthma are driven disproportionately by children with severe asthma. However, it is not known from longitudinal studies whether children outgrow severe asthma. Objective: We sought to study prospectively whether well-characterized children with severe asthma outgrow their asthma during adolescence. Methods: Children with asthma were assessed at baseline with detailed questionnaires, allergy tests, and lung function tests and were reassessed annually for 3 years. The population was enriched for children with severe asthma, as assessed by the American Thoracic Society/European Respiratory Society guidelines, and subject classification was reassessed annually. Results: At baseline, 111 (59%) children had severe asthma. Year to year, there was a decrease in the proportion meeting the criteria for severe asthma. After 3 years, only 30% of subjects met the criteria for severe asthma (P <.001 compared with enrollment). Subjects experienced improvements in most indices of severity, including symptom scores, exacerbations, and controller medication requirements, but not lung function. Surprisingly, boys and girls were equally likely to has resolved asthma (33% vs 29%). The odds ratio in favor of resolution of severe asthma was 2.75 (95% CI, 1.02-7.43) for those with a peripheral eosinophil count of greater than 436 cells/μL. Conclusions: In longitudinal analysis of this well-characterized cohort, half of the children with severe asthma no longer had severe asthma after 3 years; there was a stepwise decrease in the proportion meeting severe asthma criteria. Surprisingly, asthma severity decreased equally in male and female subjects. Peripheral eosinophilia predicted resolution. These data will be important for planning clinical trials in this population.

AB - Background: Morbidity and mortality associated with childhood asthma are driven disproportionately by children with severe asthma. However, it is not known from longitudinal studies whether children outgrow severe asthma. Objective: We sought to study prospectively whether well-characterized children with severe asthma outgrow their asthma during adolescence. Methods: Children with asthma were assessed at baseline with detailed questionnaires, allergy tests, and lung function tests and were reassessed annually for 3 years. The population was enriched for children with severe asthma, as assessed by the American Thoracic Society/European Respiratory Society guidelines, and subject classification was reassessed annually. Results: At baseline, 111 (59%) children had severe asthma. Year to year, there was a decrease in the proportion meeting the criteria for severe asthma. After 3 years, only 30% of subjects met the criteria for severe asthma (P <.001 compared with enrollment). Subjects experienced improvements in most indices of severity, including symptom scores, exacerbations, and controller medication requirements, but not lung function. Surprisingly, boys and girls were equally likely to has resolved asthma (33% vs 29%). The odds ratio in favor of resolution of severe asthma was 2.75 (95% CI, 1.02-7.43) for those with a peripheral eosinophil count of greater than 436 cells/μL. Conclusions: In longitudinal analysis of this well-characterized cohort, half of the children with severe asthma no longer had severe asthma after 3 years; there was a stepwise decrease in the proportion meeting severe asthma criteria. Surprisingly, asthma severity decreased equally in male and female subjects. Peripheral eosinophilia predicted resolution. These data will be important for planning clinical trials in this population.

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