Severe asthma in early childhood may lead to premature loss of lung function during adolescence and more serious disease during adulthood, according to a new study from researchers at Emory University School of Medicine. The study, published in the Journal for Allergy and Clinical Immunology, states that early identification and treatment of children with severe asthma is important to help stem asthma progression.
“Severe asthma in children is a challenging disorder,” says Anne M. Fitzpatrick, PhD, assistant professor of pediatrics at Emory. “It is important for physicians to identify those children with severe asthma who are at risk for lung function decline. With early identification, physicians can customize treatment plans and educate families on lifestyle changes that may help children with severe asthma breathe easier as they grow older.”
Although there are similarities between children and adults with severe asthma, recent research has shown that the limitation of airflow is not as significant in children as in adults. This raises questions about the course of severe asthma in childhood and the critical developmental time frame during which loss of lung function occurs.
The researchers in this study used data from children with mild-to-moderate and severe asthma who were enrolled in a long-term National Heart, Lung, and Blood Institute Severe Asthma Research Program. The children were ages 8-11 years at the first evaluation and 11-14 years at the follow-up visit. Comparing measurements of symptoms, medication use and lung function, the researchers analyzed changes in the children’s respiratory health over an average 3-year period.
The study found that children with severe asthma reported a higher frequency of daily symptoms and hospitalization during the previous year despite higher doses of inhaled corticosteroids (ICS) and controller medication, and that they had significantly lower lung function when compared to children with mild-to-moderate asthma. Additionally, the researchers found that daily asthma symptoms such as coughing and wheezing and sensitization to aeroallergens during the initial evaluation were strong predictors of declines in lung function of more than 1% per year.
The authors conclude that children with severe asthma have a premature loss of lung function during the adolescent years that is associated with an increased frequency of wheezing and asthma symptoms and greater allergic sensitization during childhood. They say further studies are needed to determine whether the loss of lung function is due to a slower rate of lung growth or to progressive changes in the lung tissues, and to explore the mechanisms that control the responses of severely asthmatic children to ICS treatment.
Source: Emory University School of Medicine