Asthma natural history, complications and prognosis
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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Philip Marcus, M.D., M.P.H. [2]
Natural History
Asthma in Children
Many children often develop one or more episodes of wheezing early in life. These episodes are often associated with respiratory viral infection[1]. Tucson Children's Respiratory Study which is a longitudinal birth cohort study also demonstrated that the prevalence of wheezing in presence of lower respiratory tract illness was 32%, 17% and 12% at first, second and third year of life, respectively[2]. Respiratory syncytial virus (RSV) followed by parainfluenza virus type 3 are the common causative agents identified[3][4][2]. At age of 6 years, 20% of children who had previous episodes of lower respiratory illness with wheezing during the first three years of life, had no wheezing, 13.7% of children who had wheezing before three years of age continued to have wheezing. 15% of children were reported to have new onset wheezing at 6 years of age. Majority of children with wheeze are associated with transient conditions such as viral illness which do not increase the risk of asthma later in life[5].
Prognosis
The prognosis for asthmatics is good; especially for children with mild disease. For asthmatics diagnosed during childhood, 54% will no longer carry the diagnosis after a decade. The extent of permanent lung damage in asthmatics is unclear. Airway remodelling is observed, but it is unknown whether these represent harmful or beneficial changes.[6] Although conclusions from studies are mixed, most studies show that early treatment with glucocorticoids prevents or ameliorates decline in lung function as measured by several parameters.[7] For those who continue to suffer from mild symptoms, corticosteroids can help most to live their lives with few disabilities. The mortality rate for asthma is low, with around 6000 deaths per year in a population of some 10 million patients in the United States. Better control of the condition may help prevent some of these deaths.
References
- ↑ Kusel MM, de Klerk NH, Kebadze T, Vohma V, Holt PG, Johnston SL; et al. (2007). "Early-life respiratory viral infections, atopic sensitization, and risk of subsequent development of persistent asthma". J Allergy Clin Immunol. 119 (5): 1105–10. doi:10.1016/j.jaci.2006.12.669. PMID 17353039.
- ↑ 2.0 2.1 Taussig LM, Wright AL, Holberg CJ, Halonen M, Morgan WJ, Martinez FD (2003). "Tucson Children's Respiratory Study: 1980 to present". J Allergy Clin Immunol. 111 (4): 661–75, quiz 676. PMID 12704342.
- ↑ Henderson FW, Clyde WA, Collier AM, Denny FW, Senior RJ, Sheaffer CI; et al. (1979). "The etiologic and epidemiologic spectrum of bronchiolitis in pediatric practice". J Pediatr. 95 (2): 183–90. PMID 448557.
- ↑ Denny FW, Clyde WA (1986). "Acute lower respiratory tract infections in nonhospitalized children". J Pediatr. 108 (5 Pt 1): 635–46. PMID 3009769.
- ↑ Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ (1995). "Asthma and wheezing in the first six years of life. The Group Health Medical Associates". N Engl J Med. 332 (3): 133–8. doi:10.1056/NEJM199501193320301. PMID 7800004.
- ↑ Maddox L, Schwartz DA (2002) The pathophysiology of asthma. Annu Rev Med 53 ():477-98. DOI:10.1146/annurev.med.53.082901.103921 PMID: 11818486
- ↑ Beckett PA, Howarth PH. Pharmacotherapy and airway remodelling in asthma? Thorax. 2003;58(2):163-74. PMID 12554904