Kristie R Ross1, Ritika Gupta2, Mark D DeBoer3, Joe Zein4, Brenda R Phillips5, David T Mauger5, Chun Li1, Ross E Myers1, Wanda Phipatanakul6, Anne M Fitzpatrick7, Ngoc P Ly8, Leonard B Bacharier9, Daniel J Jackson10, Juan C Celedón11, Allyson Larkin11, Elliot Israel6, Bruce Levy6, John V Fahy8, Mario Castro9, Eugene R Bleecker12, Deborah Meyers12, Wendy C Moore13, Sally E Wenzel14, Nizar N Jarjour10, Serpil C Erzurum4, W Gerald Teague3, Benjamin Gaston15. 1. Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, Ohio. 2. Department of Medicine, Case Western Reserve University School of Medicine, Cleveland. 3. Department of Pediatrics, University of Virginia, Charlottesville, Va. 4. Department of Pathobiology, Lerner Research Institute, and the Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio. 5. Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa. 6. Department of Pediatrics, Harvard University School of Medicine, Boston, Mass. 7. Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga. 8. Department of Pediatrics, San Francisco School of Medicine, University of California, San Francisco, Calif. 9. Department of Pediatrics, Washington University School of Medicine, St Louis, Mo. 10. Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis. 11. Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa. 12. Department of Medicine, University of Arizona Health Sciences, Tucson, Ariz. 13. Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC. 14. University of Pittsburgh Asthma Institute at the University of Pittsburgh Medical Center-University of Pittsburgh School of Medicine, Pittsburgh, Pa. 15. Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, Ohio. Electronic address: begaston@iu.edu.
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.
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.
Authors: Erick Forno; Diego D Brandenburg; Jose A Castro-Rodriguez; Carlos A Celis-Preciado; Fernando Holguin; Christopher Licskai; Stephanie Lovinsky-Desir; Marcia Pizzichini; Alejandro Teper; Connie Yang; Juan C Celedón Journal: Ann Am Thorac Soc Date: 2022-04
Authors: Joe G Zein; Jeffrey M McManus; Nima Sharifi; Serpil C Erzurum; Nadzeya Marozkina; Timothy Lahm; Olivia Giddings; Michael D Davis; Mark D DeBoer; Suzy A Comhair; Peter Bazeley; Hyun Jo Kim; William Busse; William Calhoun; Mario Castro; Kian Fan Chung; John V Fahy; Elliot Israel; Nizar N Jarjour; Bruce D Levy; David T Mauger; Wendy C Moore; Victor E Ortega; Michael Peters; Eugene R Bleecker; Deborah A Meyers; Yi Zhao; Sally E Wenzel; Benjamin Gaston Journal: Am J Respir Crit Care Med Date: 2021-08-01 Impact factor: 30.528