Persistence of Childhood Asthma

Researchers in Ontario, Canada examined patterns of the children's use of health services as a predictor of asthma persistence, because children with previous significant morbidity for are at increased risk for future illnesses. More than 34,000 babies (28 percent) had asthma that was diagnosed before age six years.

To understand further the natural history of asthma, the team observed young children with asthma from birth until early adolescence. In most cases, asthma was diagnosed during a physician's visit; in fewer than 10 percent of cases, it was diagnosed during a hospital admission.

During the six-year follow-up period, about 50 percent of the patients experienced another asthma episode (considered persistent asthma), and 18 percent needed acute health care, such as hospitalization and or an emergency department visit for asthma.

Sixty percent of children with persistent asthma had a second asthma physician visit one year after their diagnosis, although fewer than half of those in the remission group did so. By the third year after the diagnosis, 86 percent of children with persistent asthma had experienced a second physician visit for the illness. Overall, 84 percent of the children with asthma had a second physician visit before age 12. Overall, 54 percent of the children who had asthma in early childhood experienced a second asthma episode within a year of diagnosis, and 75 percent did so within three years after the diagnosis.

Children with asthma that had been diagnosed between the ages of two and five years were more likely to have persistent asthma by age 12 years, compared with children whose asthma was diagnosed before age two (58 percent versus 45 percent, respecitvely).

Almost 25 percent of children with asthma diagnosed before age six years also had hay fever or atopic dermatitis. Those with atopic conditions were more likely to have persistent asthma by age 12 years, compared with those without atopic conditions (63 versus 48 percent, respectively).

The time from diagnosis to the next asthma care encounter indicated that the first few years after an asthma diagnosis were crucial. For both physician visits and hospitalizations, the number of children having a second asthma encounter peaked at three years after the diagnosis and then stabilized.

(Source: Archives of Pediatric and Adolescent Medicine, 2007; 161:1197-1204.)

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