Pulmonary functions in bronchial asthma from early childhood to schoolage

Background and Methods: To assess clinical course and development of pulmonary function in asthma from early childhood to school-age a follow-up study was conducted in 100 schoolchildren (69 m, 31 f, mean age 9.1 y) diagnosed to have asthma between 6 months and 3 years of age. 75 children were re-examined at the out-patient clinic, including pulmonary function tests and a cold air challenge; for the remaining 25 we received a detailed questionnaire. Results: Five to 10 years after initial diagnosis only 27 % of the patients were clinically free of asthmatic symptoms; in 45 % symptoms had become less frequent, unchanged in 24 % and more severe in 4 %. Of 75 children only 11 (15 %) had a completely normal lung function at follow-up: Hyperinflation was observed in 35 %, central airway obstruction in 59 % and small airway obstruction in 52 %, Forty-seven children (63 %) showed either evidence of bronchial hyperresponsiveness after cold air challenge or airways obstruction (with baseline FEV1 < 70 % and/or MEF50 < 50 % predicted), such that a provocation test could not be performed. Of all symptomatic children, only 34% used inhalation treatment daily, and in only 28 % the inhalation regime was sufficient according to international consensus statements. Conclusion: We conclude that despite early diagnosis of asthma in infancy and appropriate treatment plan the majority of children remain symptomatic, This may at least partly be explained by insufficient treatment compliance, Education programs for patients and parents are urgently needed.