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ICD Code: 493. Asthma

ICD Code: 493. Article Review
Title: Panhuysen CI et al; "Adult Patients May Outgrow Their Asthma: A 25-Year Follow-Up Study." American Journal of Respiratory and Critical Care Medicine; V.155; 1997; p1267
      OUTGROWING ASTHMA: Many follow-up studies have shown that childhood airway hyperresponsiveness tends to diminish or disappear with age and that about 50% of children with asthma will have outgrown their disease by the time they reach adulthood. However, only a few studies have been published clarifying whether asthma may also recede in adults and exploring the risk factors that may influence this outcome. Bronchial hyperresponsiveness (BHR), often called "the hallmark of asthma", is known to be an important risk factor for the development of asthma and is a marker for the actual severity of disease as well as a measure for the need of therapy. The severity of BHR in childhood predicts the degree of respiratory symptoms and the level of BHR as well as the level of forced expiratory volume (FEV-1) in adulthood.
      STUDY DESIGN: This study examined a cohort of patients, who had been admitted to the asthma clinic at Beatrixoord hospital in Haren, The Netherlands, between 1962 and 1970 (Visit 1). The follow-up data were collected between 1991 and 1994 at the same clinic (Visit 2). At Visit 1, the inclusion criteria were age younger than 45 years, a 20% fall in FEV-1 during a histamine challenge test, and clinical symptoms of asthma. Between 1962 and 1970, 426 patients referred to Beatrixoord hospital fitted the inclusion criteria.
      RESULTS: Of the 181 asthmatic patients included in the analyses, a substantial proportion showed an improvement in their disease after a 25-year period. 40% became symptom-free, 21% no longer showed BHR, and 25% had a greater than 90% predicted FEV-1 even when moderate to severe disease was present at their first evaluation.
      DISCUSSION: Most studies in children report that persistent BHR is more likely in girls. In this older population, this study also found that more male patients did not show BHR at Visit 2. The multivariate analysis, however, did not show evidence for a significant effect of gender on both outgrowing BHR and outgrowing asthma. The results obtained in this study suggest that when asthma persists into adulthood, gender is of less importance for the eventual course of asthma.
      In summary, this study suggests that age and airway obstruction are the important parameters in the course of asthma in adulthood. It appears that in younger subjects with relatively less severe airway obstruction there is a good chance that their asthma will improve or that they may even outgrow it. As the untreated period from onset of asthma symptoms appears to be an important determinant in the decline of BHR, it lends support to the hypothesis that early institution of treatment is critical in asthma for both children and adults.

Search Criteria: Text - American Journal of Respiratory and Critical Care Medicine; V.155; 1997; p1267