Severe childhood asthma decreases lung function through adulthood

Children with severe, frequent symptoms of asthma experience progressive loss of lung function through adolescence into adulthood, even with high doses of controller medications.

In a study published in the Journal of Allergy and Clinical Immunology, researchers examined data from children (aged 8 to 11 years) with severe and mild to moderate asthma who were enrolled in the National Heart, Lung, and Blood Institute’s (NHLBI) Severe Asthma Research Program (SARP) at Emory University, Atlanta, Georgia, between 2004 and 2007.

After longitudinal follow-up of 40 participants (aged 11 to 14 years) between 2008 and 2010, the researchers reported that children with severe asthma compared with children with mild to moderate asthma had a higher frequency of daily symptoms (46% vs 8%, respectively) and hospitalization (32% vs 0%, respectively) within the previous year, despite higher daily doses of inhaled corticosteroids (ICSs) and increased frequency in use of controller medications. Lung function, accompanied by increased wheezing and sensitivity to allergies, also remained significantly lower in children with severe versus mild to moderate asthma at the follow-up assessment, although the magnitude of airflow limitation in children with severe asthma was significantly less than what is commonly observed in adults with severe asthma.

“The fact that airflow limitation persisted and even worsened in many children with severe asthma despite high doses of ICSs and other asthma controller medications is intriguing,“ said the researchers. They suggested that further study is needed to determine how children with severe asthma respond to ICS treatment.

Fitzpatrick AM, Teague WG; National Institutes of Health/National Heart Lung, and Blood Institute’s Severe Asthma Research Program. Progressive airflow limitation is a feature of children with severe asthma. J Allergy Clin Immunol. 2011;127(1):282-284.