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Factors in childhood as predictors of asthma in adult life

Department of Public Health and Community Medicine, University of Melbourne, Carlton, Victoria 3053, Australia Clinical Epidemiology and Biostatistics Unit, Royal Children's Hospital, Parkville, Victoria 3052, Australia Centre for Adolescent Health, University of Melbourne, Parkville, Victoria 3052, Australia Cancer Epidemiology Centre, Anti-Cancer Council of Victoria, Carlton, Victoria 3053, Australia. Correspondence to: Dr John L Hopper, Department of Public Health and Community Medicine, University of Melbourne, 200 Berkeley Street, Carlton, Victoria 3053, Australia.

Abstract

Objective: To determine which factors measured in childhood predict asthma in adult life.
Design: Prospective study over 25 years of a birth cohort initially studied at the age of 7.
Setting: Tasmania, Australia. Subjects--1494 men and women surveyed in 1991-3 when aged 29 to 32 (75% of a random stratified sample from the 1968 Tasmanian asthma survey of children born in 1961 and at school in Tasmania).
Main outcome measures: Self reported asthma or wheezy breathing in the previous 12 months (current asthma).
Results: Of the subjects with asthma or wheezy breathing by the age of 7, as reported by their parents 25.6% (190/741) reported current asthma as an adult compared with 10.8% (81/753) of subjects without parent reported childhood asthma (P<0.001). Factors measured at the age of 7 that independently predicted current asthma as an adult were being female (odds ratio 1.57; 95% confidence interval 1.19 to 2.08); having a history of eczema (1.45; 1.04 to 2.03); having a low mild forced expiratory flow rate (interquartile odds ratio 1.40; 1.15 to 1.71); having a mother or father with a history of asthma (1.74 (1.23 to 2.47) and 1.68 (1.18 to 2.38) respectively); and having childhood asthma (1.59; 1.10 to 2.29) and, if so, having the first attack after the age of 2 (1.66; 1.17 to 2.36) or having had more than 10 attacks (1.70; 1.17 to 2.48). Conclusion--Children with asthma reported by their parents in 1968 were more likely than not to be free of symptoms as adults. The subjects who had more severe asthma (especially if it developed after the age of 2 and was associated with reduced expiratory flow), were female, or had parents who had asthma were at an increased risk of having asthma as an adult. These findings have implications for the treatment and prognosis of childhood asthma, targeting preventive and educational strategies, and understanding the onset of asthma in adult life.

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Asthma trends Causes of wheeze and asthma may differ

S Ross, D Godden, G Douglas, J Legge, J Friend, H Booth, C Hartley-Sharpe, H Walters, C C Godley, R McCallum, C E Bucknall, S Kendrick, and J H Higham
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