Skip to main content

Advertisement

SpringerLink
Log in

Relevance of Birth Cohorts to Assessment of Asthma Persistence

  • ASTHMA (WJ CALHOUN AND J BOUSQUET, SECTION EDITORS)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

The definition of persistent asthma in longitudinal studies reflects symptoms reported at every assessment with no substantive asymptomatic periods. Early-childhood wheezing may be transient, especially if it is of viral etiology. Longitudinal studies provide greater opportunity to confirm the diagnosis by variability of symptoms, objective measurements, and therapeutic responses. Several clinical phenotypes of childhood asthma have been identified, with general consistency between cohorts. Persistent wheezing is often associated with loss of lung function, which is evident from early-childhood and related to persistent inflammation and airway hyperresponsiveness. Female sex, atopy, airway responsiveness, and personal smoking, but not exposure to environmental tobacco smoke, are risk factors for persistence of childhood asthma into adulthood. The effect of breastfeeding remains controversial, but gene–environment interactions may partly explain outcomes. Understanding the natural history and underlying causes of asthma may lead to development of strategies for primary prevention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Sears MR. The definition and diagnosis of asthma. Allergy. 1993;48(17):12–6 (Supp S).

    Article  PubMed  CAS  Google Scholar 

  2. Sears MR, Jones DT, Holdaway MD, et al. Prevalence of bronchial reactivity to inhaled methacholine in New Zealand children. Thorax. 1986;41(4):283–9.

    Article  PubMed  CAS  Google Scholar 

  3. Martinez FD, Wright AL, Taussig LM, et al. Asthma and wheezing in the first six years of life. N Engl J Med. 1995;332(3):133–8.

    Article  PubMed  CAS  Google Scholar 

  4. Sears MR, Greene JM, Willan AR, et al. A longitudinal, population-based, cohort study of childhood asthma followed to adulthood. N Engl J Med. 2003;349(15):1414–22.

    Article  PubMed  CAS  Google Scholar 

  5. Horak E, Lanigan A, Roberts M, et al. Longitudinal study of childhood wheezy bronchitis and asthma: outcome at age 42. BMJ. 2003;326(7386):422–3.

    Article  PubMed  Google Scholar 

  6. Almqvist C, Li Q, Britton WJ, et al. Early predictors for developing allergic disease and asthma: examining separate steps in the ‘allergic march’. Clin Exp Allergy. 2007;37(9):1296–302.

    Article  PubMed  CAS  Google Scholar 

  7. Linneberg A. The allergic march in early childhood and beyond. Clin Exp Allergy. 2008;38(9):1419–21.

    Article  PubMed  CAS  Google Scholar 

  8. •• Busse WW, Lemanske Jr RF, Gern JE. Role of viral respiratory infections in asthma and asthma exacerbations. Lancet. 2010;376(9743):826–34. This is a review of the evidence indicating that viral infections may contribute to the development of asthma and are associated with exacerbations.

    Article  PubMed  Google Scholar 

  9. Brand PLP, Baraldi E, Bisgaard H, et al. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. Eur Respir J. 2008;32(4):1096–110.

    Article  PubMed  CAS  Google Scholar 

  10. Sears M. Growing up with asthma. Br Med J. 1994;13:72–3.

    Article  Google Scholar 

  11. Taylor DR, Cowan JO, Greene JM, Willan A, Sears MR. Asthma in remission: can relapse in early adulthood be predicted at age 18 years of age. Chest. 2005;127:845–50.

    Article  PubMed  Google Scholar 

  12. Butland BK, Strachan DP. Asthma onset and relapse in adult life: the British 1958 birth cohort study. Ann Allergy Asthma Immunol. 2007;98(4):337–43.

    Article  PubMed  Google Scholar 

  13. Stern DA, Morgan WJ, Halonen M, Wright AL, Martinez FD. Wheezing and bronchial hyper-responsiveness in early childhood as predictors of newly diagnosed asthma in early adulthood: a longitudinal birth-cohort study. Lancet. 2008;372(9643):1058–64.

    Article  PubMed  Google Scholar 

  14. Martinez FD. The origins of asthma and chronic obstructive pulmonary disease in early life. Proc Am Thor Soc. 2009;6(3):272–7.

    Article  Google Scholar 

  15. Bush A. COPD: a pediatric disease. COPD. 2008;5(1):53–67.

    Article  PubMed  Google Scholar 

  16. •• Spycher BD, Silverman M, Kuehni CE. Phenotypes of childhood asthma: are they real? Clin Exp Allergy. 2010;40(8):1130–41. This is a critical appraisal of the different ways of defining asthma “phenotypes.”.

    Article  PubMed  CAS  Google Scholar 

  17. Morgan WJ, Stern DA, Sherrill DL, et al. Outcome of asthma and wheezing in the first 6 years of life: follow-up through adolescence. Am J Respir Crit Care Med. 2005;172(10):1253–8.

    Article  PubMed  Google Scholar 

  18. Matricardi PM, Illi S, Grüber C, et al. Wheezing in childhood: incidence, longitudinal patterns and factors predicting persistence. Eur Respir J. 2008;32(3):585–92.

    Article  PubMed  CAS  Google Scholar 

  19. Henderson J, Granell R, Heron J, et al. Associations of wheezing phenotypes in the first 6 years of life with atopy, lung function and airway responsiveness in mid-childhood. Thorax. 2008;63(11):974–80.

    Article  PubMed  CAS  Google Scholar 

  20. Savenije OE, Granell R, Caudri D, et al. Comparison of childhood wheezing phenotypes in 2 birth cohorts: ALSPAC and PIAMA. J Allergy Clin Immunol. 2011;127(6):1505–12.e14.

    Article  PubMed  Google Scholar 

  21. Spycher BD, Silverman M, Brooke AM, Minder CE, Kuehni CE. Distinguishing phenotypes of childhood wheeze and cough using latent class analysis. Eur Respir J. 2008;31(5):974–81.

    Article  PubMed  CAS  Google Scholar 

  22. •• Strippoli M-PF, Spycher BD, Pescatore AM, Beardsmore CS, Silverman M, Kuehni CE. Exclusive viral wheeze and allergic wheeze: evidence for discrete phenotypes. Eur Respir J. 2011;38(2):472–4. This is a brief report demonstrating different and independent mechanisms for wheeze in children.

    Article  PubMed  Google Scholar 

  23. Jackson DJ, Gangnon RE, Evans MD, et al. Wheezing rhinovirus illnesses in early life predict asthma development in high-risk children. Am J Respir Crit Care Med. 2008;178(7):667–72.

    Article  PubMed  Google Scholar 

  24. Devulapalli CS, Carlsen KC, Haland G, et al. Severity of obstructive airways disease by age 2 years predicts asthma at 10 years of age. Thorax. 2008;63(1):8–13.

    Article  PubMed  CAS  Google Scholar 

  25. Young S, Sherrill DL, Arnott J, Diepeveen D, LeSouef PN, Landau LI. Parental factors affecting respiratory function during the first year of life. Pediatr Pulmonol. 2000;29(5):331–40.

    Article  PubMed  CAS  Google Scholar 

  26. Turner SW, Palmer LJ, Rye PJ, et al. Infants with flow limitation at 4 weeks: outcome at 6 and 11 years. Am J Respir Crit Care Med. 2002;165(9):1294–8.

    Article  PubMed  Google Scholar 

  27. Turner SW, Palmer LJ, Rye PJ, et al. The relationship between infant airway function, childhood airway responsiveness, and asthma. Am J Respir Crit Care Med. 2004;169(8):921–7.

    Article  PubMed  Google Scholar 

  28. Illi S, von Mutius E, Lau S, Niggemann B, Gruber C, Wahn U. Perennial allergen sensitisation early in life and chronic asthma in children: a birth cohort study. Lancet. 2006;368(9537):763–70.

    Article  PubMed  Google Scholar 

  29. Lau S, Illi S, Sommerfeld C, et al. Transient early wheeze is not associated with impaired lung function in 7-yr-old children. Eur Respir J. 2003;21(5):834–41.

    Article  PubMed  CAS  Google Scholar 

  30. Lowe LA, Simpson A, Woodcock A, Morris J, Murray CS, Custovic A. Wheeze phenotypes and lung function in preschool children. Am J Respir Crit Care Med. 2005;171(3):231–7.

    Article  PubMed  Google Scholar 

  31. Oostveen E, Dom S, Desager K, Hagendorens M, De Backer W, Weyler J. Lung function and bronchodilator response in 4-year-old children with different wheezing phenotypes. Eur Respir J. 2010;35(4):865–72.

    Article  PubMed  CAS  Google Scholar 

  32. Håland G, Carlsen KCL, Sandvik L, et al. Reduced lung function at birth and the risk of asthma at 10 years of age. N Engl J Med. 2006;355(16):1682–9.

    Article  PubMed  Google Scholar 

  33. Delacourt C, Benoist M-R, Le Bourgeois M, et al. Relationship between bronchial hyperresponsiveness and impaired lung function after infantile asthma. PLoS One. 2007;2(11):e1180.

    Article  PubMed  Google Scholar 

  34. Oswald H, Phelan PD, Lanigan A, et al. Childhood asthma and lung function in mid-adult life. Pediatr Pulmonol. 1997;23(1):14–20.

    Article  PubMed  CAS  Google Scholar 

  35. Goksör E, Gustafsson PM, Alm B, Amark M, Wennergren G. Reduced airway function in early adulthood among subjects with wheezing disorder before two years of age. Pediatr Pulmonol. 2008;43(4):396–403.

    Article  PubMed  Google Scholar 

  36. Stern DA, Morgan WJ, Wright AL, Guerra S, Martinez FD. Poor airway function in early infancy and lung function by age 22 years: a non-selective longitudinal cohort study. Lancet. 2007;370(9589):758–64.

    Article  PubMed  Google Scholar 

  37. Grol MH, Gerritsen J, Vonk JM, et al. Risk factors for growth and decline of lung function in asthmatic individuals up to age 42 years. A 30-year follow-up study. Am J Respir Crit Care Med. 1999;160(6):1830–7.

    PubMed  CAS  Google Scholar 

  38. Saglani S, Payne DN, Zhu J, et al. Early detection of airway wall remodeling and eosinophilic inflammation in preschool wheezers. Am J Respir Crit Care Med. 2007;176(9):858–64.

    Article  PubMed  Google Scholar 

  39. Covar RA, Strunk R, Zeiger RS, et al. Predictors of remitting, periodic, and persistent childhood asthma. J Allergy Clin Immunol. 2010;125(2):359–66.e3.

    Article  PubMed  Google Scholar 

  40. Debley JS, Stamey DC, Cochrane ES, Gama KL, Redding GJ. Exhaled nitric oxide, lung function, and exacerbations in wheezy infants and toddlers. J Allergy Clin Immunol. 2010;125(6):1228–34.e13.

    Article  PubMed  CAS  Google Scholar 

  41. Wilson NM, Lamprill JR, Mak JCW, Clarke JR, Bush A, Silverman M. Symptoms, lung function, and beta2-adrenoceptor polymorphisms in a birth cohort followed for 10 years. Pediatr Pulmonol. 2004;38(1):75–81.

    Article  PubMed  Google Scholar 

  42. Palmer LJ, Rye PJ, Gibson NA, Burton PR, Landau LI, Lesouef PN. Airway responsiveness in early infancy predicts asthma, lung function, and respiratory symptoms by school age. Am J Respir Crit Care Med. 2001;163(1):37–42.

    PubMed  CAS  Google Scholar 

  43. Broide DH. Immunologic and inflammatory mechanisms that drive asthma progression to remodeling. J Allergy Clin Immunol. 2008;121(3):560–70.

    Article  PubMed  CAS  Google Scholar 

  44. Guerra S, Martinez FD. Epidemiology of the origins of airflow limitation in asthma. Proc Am Thorac Soc. 2009;6(8):707–11.

    Article  PubMed  Google Scholar 

  45. Hanxiang N, Jiong Y, Yanwei C, et al. Persistent airway inflammation and bronchial hyperresponsiveness in patients with totally controlled asthma. Int J Clin Pract. 2008;62(4):599–605.

    Article  PubMed  CAS  Google Scholar 

  46. Postma DS. Gender differences in asthma development and progression. Gend Med. 2007;4(Suppl B):S133–46.

    Article  PubMed  Google Scholar 

  47. Jenkins MA, Hopper JL, Bowes G, Carlin JB, Flander LB, Giles GG. Factors in childhood as predictors of asthma in adult life. BMJ. 1994;309(6947):90–3.

    Article  PubMed  CAS  Google Scholar 

  48. Burgess JA, Matheson MC, Gurrin LC, et al. Factors influencing asthma remission: a longitudinal study from childhood to middle age. Thorax. 2011;66(6):508–13.

    Article  PubMed  Google Scholar 

  49. Sly PD, Boner AL, Bjorksten B, et al. Early identification of atopy in the prediction of persistent asthma in children. Lancet. 2008;372(9643):1100–6.

    Article  PubMed  Google Scholar 

  50. Rhodes HL, Sporik R, Thomas P, Holgate ST, Cogswell JJ. Early life risk factors for adult asthma: a birth cohort study of subjects at risk. J Allergy Clin Immunol. 2001;108(5):720–5.

    Article  PubMed  CAS  Google Scholar 

  51. Lodge CJ, Lowe AJ, Gurrin LC, et al. House dust mite sensitization in toddlers predicts current wheeze at age 12 years. J Allergy Clin Immunol. 2011;128(4):782–8.e9.

    Article  PubMed  Google Scholar 

  52. Kusel MM, Kebadze T, Johnston SL, Holt PG, Sly PD. Febrile respiratory illnesses in infancy & atopy are risk factors for persistent asthma & wheeze. Eur Respir J. 2011. doi:10.1183/09031936.00193310.

  53. Strachan DP, Butland BK, Anderson HR. Incidence and prognosis of asthma and wheezing illness from early childhood to age 33 in a national British cohort. BMJ. 1996;312(7040):1195–9.

    Article  PubMed  CAS  Google Scholar 

  54. Wolfe R, Carlin JB, Oswald H, Olinsky A, Phelan PD, Robertson CF. Association between allergy and asthma from childhood to middle adulthood in an Australian cohort study. Am J Respir Crit Care Med. 2000;162(6):2177–81.

    PubMed  CAS  Google Scholar 

  55. Castro-Rodriguez JA, Holberg CJ, Wright AL, Martinez FD. A clinical index to define risk of asthma in young children with recurrent wheezing. Am J Respir Crit Care Med. 2000;162(4 Pt 1):1403–6.

    PubMed  CAS  Google Scholar 

  56. Weiss KB, Wagener DK. Changing patterns of asthma mortality. Identifying target populations at high risk. JAMA. 1990;264(13):1683–7.

    Article  PubMed  CAS  Google Scholar 

  57. Young S, Arnott J, O’Keeffe PT, Le Souef PN, Landau LI. The association between early life lung function and wheezing during the first 2 yrs of life. Eur Respir J. 2000;15(1):151–7.

    Article  PubMed  CAS  Google Scholar 

  58. Dezateux C, Stocks J, Wade AM, Dundas I, Fletcher ME. Airway function at one year: association with premorbid airway function, wheezing, and maternal smoking. Thorax. 2001;56(9):680–6.

    Article  PubMed  CAS  Google Scholar 

  59. Stick SM, Burton PR, Gurrin L, Sly PD, LeSouef PN. Effects of maternal smoking during pregnancy and a family history of asthma on respiratory function in newborn infants. Lancet. 1996;348(9034):1060–4.

    Article  PubMed  CAS  Google Scholar 

  60. De Sario M, Di Domenicantonio R, Corbo G, et al. Characteristics of early transient, persistent, and late onset wheezers at 9 to 11 years of age. J Asthma. 2006;43(8):633–8.

    Article  PubMed  Google Scholar 

  61. Stein RT, Holberg CJ, Sherrill D, et al. Influence of parental smoking on respiratory symptoms during the first decade of life: the Tucson children’s respiratory study. Am J Epidemiol. 1999;149(11):1030–7.

    Article  PubMed  CAS  Google Scholar 

  62. Lewis S, Richards D, Bynner J, Butler N, Britton J. Prospective study of risk factors for early and persistent wheezing in childhood. Eur Respir J. 1995;8(3):349–56.

    Article  PubMed  CAS  Google Scholar 

  63. Sears MR, Holdaway MD, Flannery EM, Herbison GP, Silva PA. Parental and neonatal risk factors for atopy, airway hyperresponsiveness and asthma. Arch Dis Childhood. 1996;75(5):392–8.

    Article  CAS  Google Scholar 

  64. Kulig M, Luck W, Lau S, et al. Effect of pre and postnatal tobacco smoke exposure on specific sensitization to food and inhalant allergens during the first 3 years of life. Allergy. 1999;54(3):220–8.

    Article  PubMed  CAS  Google Scholar 

  65. Lau S, Nickel R, Niggemann B, et al. The development of childhood asthma: lessons from the German Multicentre Allergy Study (MAS). Paediatr Respir Rev. 2002;3(3):265–72.

    Article  PubMed  Google Scholar 

  66. Strachan DP, Cook DG. Health effects of passive smoking. 5. Parental smoking and allergic sensitisation in children. Thorax. 1998;53(2):117–23.

    Article  PubMed  CAS  Google Scholar 

  67. Hancox RJ, Welch D, Poulton R, et al. Cigarette smoking and allergic sensitization: a 32-year population-based cohort study. J Allergy Clin Immunol. 2008;121(1):38–42 e3.

    Article  PubMed  CAS  Google Scholar 

  68. Murray CS, Woodcock A, Smillie FI, Cain G, Kissen P, Custovic A. Tobacco smoke exposure, wheeze, and atopy. Pediatr Pulmonol. 2004;37(6):492–8.

    Article  PubMed  Google Scholar 

  69. Linneberg A, Nielsen NH, Madsen F, Frolund L, Dirksen A, Jorgensen T. Smoking and the development of allergic sensitization to aeroallergens in adults: a prospective population-based study. The Copenhagen allergy study. Allergy. 2001;56(4):328–32.

    Article  PubMed  CAS  Google Scholar 

  70. Barbee RA, Kaltenborn W, Lebowitz MD, Burrows B. Longitudinal changes in allergen skin test reactivity in a community population sample. J Allergy Clin Immunol. 1987;79(1):16–24.

    Article  PubMed  CAS  Google Scholar 

  71. Fewtrell M, Wilson DC, Booth I, Lucas A. Six months of exclusive breast feeding: how good is the evidence? BMJ. 2011;342.

  72. Wright AL, Holberg CJ, Taussig LM, Martinez FD. Factors influencing the relation of infant feeding to asthma and recurrent wheeze in childhood. Thorax. 2001;56(3):192–7.

    Article  PubMed  CAS  Google Scholar 

  73. Sears MR, Greene JM, Willan AR, et al. Long-term relation between breastfeeding and development of atopy and asthma in children and young adults: a longitudinal study. Lancet. 2002;360(9337):901–7.

    Article  PubMed  Google Scholar 

  74. ••Brew BK, Allen CW, Toelle BG, Marks GB. Systematic review and meta-analysis investigating breast feeding and childhood wheezing illness. Paediatr Perinat Epidemiol. 2011;25(6):507–18. This is a recent meta-analysis of this very controversial topic. The conclusion is that there is no evidence to indicate that breastfeeding protects against wheezing illness beyond age 5 years.

    Article  PubMed  Google Scholar 

  75. Standl M, Sausenthaler S, Lattka E, et al. FADS gene cluster modulates the effect of breastfeeding on asthma. Results from the GINIplus and LISAplus studies. Allergy. 2012;67(1):83–90.

    Article  PubMed  CAS  Google Scholar 

  76. Hong X, Wang G, Liu X, et al. Gene polymorphisms, breast-feeding, and development of food sensitization in early childhood. J Allergy Clin Immunol. 2011;128(2):374–81 e2.

    Article  PubMed  CAS  Google Scholar 

  77. Sonnenschein-van der Voort AMM, Jaddoe VWV, van der Valk RJP, et al. Duration and exclusiveness of breastfeeding and childhood asthma-related symptoms. Eur Respir J. 2012;39(1):81–9.

    Article  PubMed  CAS  Google Scholar 

  78. Duncan JM, Sears MR. Breastfeeding and allergies: time for a change in paradigm? Curr Opin Allergy Clin Immunol. 2008;8(5):398–405.

    Article  PubMed  Google Scholar 

  79. Holloway JW, Arshad SH, Holgate ST. Using genetics to predict the natural history of asthma? J Allergy Clin Immunol. 2010;126(2):200–9.

    Article  PubMed  Google Scholar 

  80. Holgate ST, Davies DE, Powell RM, Howarth PH, Haitchi HM, Holloway JW. Local genetic and environmental factors in asthma disease pathogenesis: chronicity and persistence mechanisms. Eur Respir J. 2007;29(4):793–803.

    Article  PubMed  CAS  Google Scholar 

  81. North ML, Ellis AK. The role of epigenetics in the developmental origins of allergic disease. Ann Allergy Asthma Immunol. 2011;106(5):355–61.

    Article  PubMed  CAS  Google Scholar 

  82. ••ISAAC Steering Committee. International Study of Asthma and Allergies in Childhood. ISAAC Steering Committee. 2011. http://isaac.auckland.ac.nz/. Accessed 7th January 2012. This is not a birth cohort, but rather the world’s largest epidemiologic investigation with a wealth of information on epidemiologic and ecological associations among asthma, wheeze, atopy, and environmental factors.

  83. Kuehni CE, Brooke AM, Silverman M. Prevalence of wheeze during childhood: retrospective and prospective assessment. Eur Respir J. 2000;16(1):81–5.

    Article  PubMed  CAS  Google Scholar 

  84. Nicholas C, Wegienka G, Havstad S, Ownby D, Johnson CC, Zoratti E. How accurately do young adults recall childhood pets? a validation study. Am J Epidemiol. 2009;170(3):388–92.

    Article  PubMed  Google Scholar 

  85. Promislow JHE, Gladen BC, Sandler DP. Maternal recall of breastfeeding duration by elderly women. Am J Epidemiol. 2005;161(3):289–96.

    Article  PubMed  Google Scholar 

  86. Clarke JR, Reese A, Silverman M. Bronchial responsiveness and lung function in infants with lower respiratory tract illness over the first six months of life. Arch Dis Childhood. 1992;67(12):1454–8.

    Article  CAS  Google Scholar 

  87. •• Martinez FD. New insights into the natural history of asthma: primary prevention on the horizon. J Allergy Clin Immunol. 2011;128(5):939–45. This is a review of findings from birth cohorts and primary prevention studies that suggests that interactions between viral infections and allergic sensitization may cause asthma and may point the way to primary prevention strategies.

    Article  PubMed  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand

    Robert J. Hancox

  2. Division of Pediatric Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

    Padmaja Subbarao

  3. Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue E, Hamilton, Ontario, L8N 4A6, Canada

    Malcolm R. Sears

Authors
  1. Robert J. Hancox
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Padmaja Subbarao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Malcolm R. Sears
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Malcolm R. Sears.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hancox, R.J., Subbarao, P. & Sears, M.R. Relevance of Birth Cohorts to Assessment of Asthma Persistence. Curr Allergy Asthma Rep 12, 175–184 (2012). https://doi.org/10.1007/s11882-012-0255-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11882-012-0255-6

Keywords

Search

Navigation