Severe Childhood Asthma: Long-Term Consequences Persist Into Late Adulthood

Among adults aged ≥65 years with a history of severe childhood asthma, only 1 in 10 achieved asthma remission, while 1 in 3 developed persistent airflow limitation, according to a 60-year follow-up study published in Chest¹.

This Danish cohort comprised individuals who, between 1950 and 1979, had undergone a 4-month stay at an asthma care facility in Kongsberg, Norway. Researchers reassessed participants after an average of six decades through questionnaires, spirometry, FeNO testing, bronchodilator reversibility, mannitol challenge, and static lung volume measurements. Asthma remission was defined as no symptoms and no medication use in the preceding year; all others were classified as having current asthma.

Of 1,394 eligible participants, 232 (mean age 66.1 years) completed follow-up. Remission was rare—only 10.3% met the criteria—while 89.7% had ongoing asthma. More than a quarter (26%) reported exacerbations in the past year, and 21.6% had received antibiotics for lower airway infections. Despite persistent disease, only 15.7% were under secondary care.

Controller therapy use was high (83% of those with current asthma), with two-thirds using short-acting β₂-agonists as relievers. Allergic rhinitis (60%), hypertension (21%), eczema (16%), and cataract (8%) were common comorbidities. Compared with those in remission, participants with persistent asthma had:

• Higher total IgE
• Lower FEV₁ % predicted and reduced FEV₁/FVC ratio
• Numerically higher FeNO (26.7 vs 20.1 ppb) and blood eosinophils (0.19 vs 0.17 ×10⁹/L)

The authors note that their definition of remission emphasizes patient-reported outcomes, acknowledging possible discrepancies between prescribed and actual treatment use.

This landmark follow-up underscores that severe asthma in childhood is a major risk factor for impaired lung function and type 2 airway inflammation in later life. The fact that nearly 90% of patients had persistent asthma into their late 60s highlights the need for long-term monitoring and early interventions aimed at altering disease trajectory.

Reference

1. Savran O, et al. Characteristics of adults with severe asthma in childhood: a 60-year follow-up study. Chest. 2024;166(4):676-684. doi:10.1016/j.chest.2024.06.005