Prognosis For Asthma From Childhood To Adulthood

Although asthma is a significant, non-communicable disease affecting individuals of all ages, it's more common among children. In 2019, approximately 455,000 deaths¹ were reported resulting from asthma worldwide.

The good news is that you can manage the disease with proper prevention measures and inhaled treatment. Therefore, you should seek education and support about asthma to self-manage the condition and prevent it from interfering with your daily life.

Before we discuss asthma prognosis, let's first understand the disease.

What is asthma?

Asthma is a chronic, long-term lung disease. It attacks your airways, the tubes carrying air in and out of your lungs, making them narrowed and inflamed.

As a result, you'll experience coughing, wheezing, and chest tightness if you have asthma. An asthma attack/flare-up occurs when the symptoms get worse.

Prognosis for asthma

Generally, the prognosis for asthma is good. You can easily control the disease thanks to multiple therapies and medications.

However, the symptoms and control measures vary from individual to individual. Some can easily manage the symptoms with prescribed medications, while others require special attention and treatments.

But generally, the disease does not produce long-term severe respiratory consequences, at least for most people.

It's worth noting that you lose some lung function as you age. However, some activities and lifestyles may exacerbate lung function loss. For instance,  lung function loss is more rapid in people with asthma who smoke.

Generally, asthma is considerably different across the life course.²

Asthma prognosis during childhood

The course of asthma varies in childhood, although the disease is considered chronic in the early stages of life. Around 60%³ of asthmatic children at seven years of age won’t grow up to be asthmatics.

Additionally, around 5% of the general population has persistent symptoms from childhood to adulthood.

Symptoms of the clinical syndrome of asthma in children include:

• Shortness of breath

• Wheezing

• Cough

• Chest tightness

In addition to these symptoms, asthmatic children might experience bronchial hyperresponsiveness (BHR) and variable expiratory flow limitation.

Asthma is considered a syndrome, not a single disease because the symptoms stem from different (inflammatory) subtypes. Therefore, a variation exists both in the course and subtypes of asthma.

Predictive factors for the course of asthma

Multiple factors are linked to asthma remission, including middle initial disease, a lower degree of BHR, lack of comorbidity and allergic sensitization, and better lung function.

Let's discuss some of the predictive factors for the course of asthma.

Bronchial hyperresponsiveness

BHR is reversible excessive airway constriction that stems from external stimuli. It is a defining feature of asthma diagnosis and helps predict asthma's long-term course. For instance, if the degree of BHR is lower in your childhood, it signals a more benign disease trajectory, particularly if you have mild to moderate asthma.

Lung function

If you have a low lung function in your early life, your chances of developing asthma later in life are high. Decreased lung function can be a symptom of asthma and a remission and persistence predictor.

Sex 

Boys/male children are more likely to get asthma than girls/female children. This trend goes at least until 20 years of age, after which the prevalence is about equal until 40 years of age, and asthma becomes more common in females after that.

Although the exact cause is unknown, it is hypothesized to either be due to boys having smaller airways than girls below age ten or the greater prevalence of atopy in young boys.

Therefore, sex and puberty significantly affect the course of asthma in early childhood. Furthermore, the outcome is triggered by sex hormones which impact airway development and homeostasis.

Family history

Asthma is partly genetic. If you or your spouse have asthma, the chances of passing the disease down to your offspring are high.  The heritability of asthma is as high as 80%.⁴

Furthermore, a child born with a maternal asthma history is more likely to develop asthma. However, pathogenesis is a complex interchange between genetic and environmental factors. Also, you cannot pass down the disease directly to your children.

Genetics alone won't determine your risk of developing asthma in early childhood or adulthood. Instead, it is a risk factor and can help determine your severity, susceptibility, and medication response.

Environmental risks

Various environmental factors can increase the risk of developing childhood asthma. For instance, if you smoke while pregnant, you place your unborn child at high risk of developing asthma. 

Additionally, maternal diet⁵ is also an environmental risk factor for childhood asthma. For instance, if you take diets rich in high sugar while pregnant, your children are more likely to get asthma. 

Conversely, some diets, like those high in zinc, vitamin E, and polyunsaturated fatty acids, can minimize the risks of childhood asthma to your offspring.

Other environmental components that increase the risk of childhood asthma include exposure to dust mites, pollen, mold, smoke, air pollution, and viral respiratory infections.

Maternal preeclampsia, neonatal jaundice, and cesarean section are risk factors for childhood asthma development.

Prognosis of asthma in adulthood

Although considered a childhood disease, asthma is also common in adults. 

But since it's a heterogeneous disease, the prognosis of asthma in adulthood is complex. 

Regardless of the twist, adult on-set asthma takes a completely different course than childhood asthma. The disease is mild, and remission is frequent in childhood asthma.

If you're asthmatic during adulthood, the disease will be more severe and progressive, and remission will be rare.

The form and risk factors for adult asthma differ from childhood asthma. For instance, while male children are at high risk of developing asthma, the risk shifts to females during adulthood. However, the risk is the same at puberty in males and females.

The female predominance of the disease beyond puberty is still a puzzle. Some observations have linked the predominance to women's small airways in adulthood, while others associate it with female hormonal changes.

If you develop asthma in adulthood, your lung function might decline, diagnosed by changes in spirometry. Adults are more likely to die from asthma.

The lowdown 

Asthma is a common disease affecting people of all ages. However, children (particularly males) are more likely to develop the disease. Some predictive factors for childhood asthma include lung function, sex, family history, and BHR.

In adulthood asthma, females are at greater risk of contracting the disease than males. However, asthma prognosis in adulthood is much more complex.

FAQs

What is the prognosis for asthma in childhood?

Although asthma is chronic in childhood, the course varies depending on several factors. Also, some children may have more prominent symptoms while others do not.

What are the risk factors for the development of childhood asthma?

Some risk factors for childhood asthma include lung function, sex, family history, and environmental risks.

Who is more likely to develop asthma?

In childhood, males are at high risk of developing asthma. At puberty, the risk is equal in males and females. However, in adulthood, females are more likely to develop asthma.