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ICD Code: 493. Asthma



ICD Code: 493. Article Review
Title: Settipane GA et al; "Natural History of Asthma: A 23-Year Followup of College Students." Annals of Allergy, Asthma, and Immunology; V.84; 5/00; p499
      STUDY DESIGN: The authors initially evaluated U.S. college freshmen for evidence of asthma and allergic rhinitis using personal interviews, physical examination, laboratory tests, and allergy skin tests. In addition, the authors confirmed the medical history by correspondence with parents/guardians. The advantages of this population study is that it represents a homogenous population of similar age, environment, and intelligence. These students were evaluated again by detailed questionnaires at intervals of 3, 7, and 23 years. For the 23-year follow-up study, the authors present data on 738 individuals (mean age at follow-up, 40 years) who were skin tested as freshmen and who completed the 23-year follow-up questionnaire. These students had additional advantages in that they were not only skin tested but also were interviewed a second time on the day of testing.
      PREVALENCE: In the initial study, the frequency of asthma was 5.3%. In the 3-year follow-up study, the cumulative prevalence increased to nearly 6%. The 7-year follow-up study was of particular significance because it showed the risk of developing asthma to be significantly increased in those individuals with previous allergic rhinitis (seasonal or nonseasonal) when compared with controls (6.0% versus 1.3%). The results of the 23-year follow-up study demonstrated that the prevalence of asthma continues to increase as the individuals become older; the cumulative incidence of asthma was 11.3%.
      PROGNOSIS: The authors reviewed long-term studies on prognosis of asthma, which showed that the frequency of asthma that became inactive varied between 47% and 75%. Major problems with comparing these prognostic studies are the types of population, design, and criteria used for inactive asthma. Nevertheless, it seems that most of these prognostic studies demonstrate that the majority of asthma cases in children and young adults improve. The finding that 4.8% of the total asthma patients reported severe asthma or worsening of symptoms was similar to other studies with 20 years or longer of follow-up.
      COEXISTING ALLERGIC RHINITIS: This study revealed the frequent coexistence of asthma and allergic rhinitis. 85.7% of the asthmatics had a history of allergic rhinitis (seasonal and/or nonseasonal). Among the individuals with a cumulative prevalence of allergic rhinitis, 21.3% had a history of asthma. During this 23-year period, those with allergic rhinitis had about 3 times the risk of developing new asthma when compared with controls (10.5% versus 3.6%). This study found that most (61%) of the asthmatic individuals had one or more positive allergy skin tests. Other authors who used controls in their studies similarly demonstrated that 58% to 72% of asthmatic patients had some form of allergy.

Search Criteria: Text - Annals of Allergy, Asthma, and Immunology; V.84; 5/00; p499