"Will My Child Grow Out Of Asthma?"

This is a question that is asked at least once weekly in my office. When children have lived with the diagnosis (of asthma) well past first grade, the answer is usually the same. Asthma is a genetic based disease which currently has no cure but can be well controlled in the majority of instances. Some young children are fortunate to have a remission period as they reach late adolescence. Many of those who experience a remission period have more asthma symptoms years later. Generally speaking, asthma is a life long disease.

But what about the younger child with wheezing in the first three years of life?

Actually a number of studies have followed children from infancy in order to analyze the natural course of the early wheezer. A study out of Tucson, Arizona (Tucson Children’s Respiratory Study) looked at 1,246 neonates over a 4 year period, and established three subclasses of wheezing children.

Transient Early Wheezing

About 60% were in this class (the largest class).

These children tended to have:

-Recurrent wheezing in the first year of life (sometimes very severe episodes)

-Typically chest symptoms were gone by 4 to six years of age

-Some major associations were: maternal smoking during pregnancy, poor lung function early on, male gender, day-care exposure, older siblings in the home and bottle propping in the baby bed or crib (thought to cause some reflux, especially after feedings)

Nonatopic Wheezing

About 20% of the children were in this category.

Their characteristics were:

-Premature birth was much more common

-A wheezing lower respiratory tract infection before one year of age was very common

-90% of these children had no further chest symptoms by school age (5)

-The majority had normal lung function at puberty

-Commonly effects children in developing countries and those in inner city areas of big cities in the U.S.

-RSV (Respiratory Syncytial Virus) was a common cause of the lower respiratory infection in these children

Atopic Wheezing

This group represented another 20% of the total studied.

These children represented the subset that more often went on to have asthma:

-Typically had a personal or family history of environmental allergic hypersensitivity

-Somewhat later episodes of intial wheezing compared to the other groups (first wheezing in 2nd or 3rd year of life)

-Reduced lung function at 6 years of age

-More common in the males, if either parent had asthma, if the child had allergic eczema, eosinophilia in infancy (measured in a routine CBC with differential- Total red and white blood count)

Bottom Line

Asthma is a disease which has many possible presentations (cough, wheeze, chest tightness, shortness of breath, chest pain). It represents interplay between genetics and environment. Young children, pre-school age, commonly wheeze. The likelihood that they will grow out of it is strongly associated with the presence or absence of allergic problems or family history of allergic airway problems. The child that from infancy on, has fewer wheezing episodes, no personal or family history of other allergic problems and good lung function at school age, has a good chance of not having asthma.

Tucson Study: Martinez f., Godfrey S. Epidemiology of wheezing in infants and young children. In: Martinez F, Godfrey S, eds. Wheezing Disorders in the Preschool: Pathophysiology and Management. London NY: Martin Dunitz 2003:1-19.