Mary Roberts

The association between childhood asthma and adult chronic obstructive pulmonary disease

Introduction There is epidemiological evidence to suggest that events in childhood influence lung growth and constitute a significant risk for adult COPD. The aim of the study is to evaluate for an association between childhood asthma and adult COPD. Methods This longitudinal, prospective study of 6–7-year-old children with asthma has been regularly reviewed every 7 years to the current analysis at 50 years of age. Participants completed respiratory questionnaires and lung function spirometry with postbronchodilator response. At the age of 50, subjects were classified to the following subgroups: non-asthmatics, asthma remission, current asthma and COPD which was defined by FEV1 to FVC ratio postbronchodilator of less than 0.7. Results Of the remaining survivors, 346 participated in the current study (participation rate of 76%) of whom 197 completed both questionnaire and lung function testing. As compared with children without symptoms of wheeze to the age of 7, (non-asthmatics) children with severe asthma had an adjusted 32 times higher risk for developing COPD (95% CI 3.4 to 269). In this cohort, 43% of the COPD group had never smoked. There was no evidence of a difference in the rate of decline in FEV1 (mL/year, 95th CI) between the COPD group (17, 10 to 23) and the other groups: non-asthmatics (16, 12 to 21), asthma remission (20, 16 to 24) and current asthma (19, 13 to 25). Conclusions Children with severe asthma are at increased risk of developing COPD.

Longitudinal study of childhood wheezy bronchitis and asthma: outcome at age 42

Longitudinal studies have reported that asthma in childhood has a good prognosis. However, most of these studies have not taken into account the severity of childhood symptoms.1 The Melbourne Epidemiological Study of Childhood Asthma recruited children at age 7 years and followed them up through adolescence to adulthood.2–5 This report describes outcome at age 42 years in relation to symptoms in childhood. In 1964, 401 children (295 with asthma and 106 controls) were randomly selected from a total of 30 000 7 year olds living in metropolitan Melbourne. A further 83 children with severe asthma were included from the same cohort in 1967, at age 10. 2 3 Original data were available for 479 participants. …

Trends in eczema, rhinitis, and rye grass sensitization in a longitudinal asthma cohort

BACKGROUND Atopic conditions are prevalent in the Western world, with limited long-term data on atopic trends in patients with asthma. OBJECTIVE To describe the trends in eczema, rhinitis, and allergic sensitization in a longitudinal childhood asthma cohort. METHODS Four hundred eighty-four patients were recruited at 7 years of age and followed regularly to 50 years of age. Subjects completed an interviewer-administered questionnaire to define current eczema and rhinitis. Skin prick testing to rye grass also was performed. RESULTS The participation rate over the past 4 decades has been maintained at 72% to 91%. There was a decrease in the prevalence of eczema in the past 12 months in groups with viral-associated wheeze (21% to 8%, P = .002), asthma (47% to 18%, P < .001), and severe asthma (69% to 28%, P < .001) from 14 to 21 years of age. Conversely, there was an increase in the prevalence of rhinitis in the previous 12 months in groups without asthma (1% to 6%, P = .04; 1% to 20%, P = .008), with viral-associated wheeze (16% to 28%, P = .006; 16% to 49%, P < .001), and with asthma (45% to 56%, P = .2; 45% to 73%, P = .014) from recruitment to 10 and 14 years of age, respectively. There were 2 peaks in prevalence in the sensitization to rye grass in this cohort from 7 to 10 years of age and from 14 to 21 years of age in all groups. CONCLUSION The adolescence phase appears to be an important period in the bodys response to allergens whereby eczema decreases in prevalence, whereas rhinitis and rye grass sensitization increase in prevalence.

Effect of detergent-coated versus non-coated spacers on bronchodilator response in children with asthma

Objective:  Previous studies have demonstrated that coating spacers with ionic detergents minimizes the static charge and thereby improves in vivo drug deposition. The present study aims to examine the effect of coated spacers versus non‐coated spacers in the clinical situation.