Natural history of asthma: Persistence versus progression-does the beginning predict the end?

Reynold A. Panettieri, Ronina Covar, Evalyn Grant, Elizabeth V. Hillyer, Leonard Bacharier

Research output: Contribution to journalArticlepeer-review

63 Scopus citations


Environmental exposures during the early years and airway obstruction that develops during this time, in conjunction with genetic susceptibility, are important factors in the development of persistent asthma in childhood. Established risk factors for childhood asthma include frequent wheezing during the first 3 years, a parental history of asthma, a history of eczema, allergic rhinitis, wheezing apart from colds, and peripheral blood eosinophilia, as well as allergic sensitization to aeroallergens and certain foods. Risk factors for the development of asthma in adulthood remain ill defined. Moreover, reasons for variability in the clinical course of asthma-persistence in some individuals and progression in others-remain an enigma. The distinction between disease persistence and disease progression suggests that these are different entities or phenotypes. There is currently no consensus on whether disease progression requires either airway inflammation or airway remodeling or the combination of the two. For patients with irreversible airway obstruction, inflammation might, in part, be necessary but perhaps not entirely sufficient to induce the irreversible component, some of which could be attributed to alterations in the structure of the bronchial wall. Intervening with intermittent or daily inhaled corticosteroids in high-risk infants and children does not prevent disease progression or impaired lung growth. These findings, however, might not apply to adults, and further study in adults is needed to determine the effect of inhaled corticosteroid therapy on disease progression.

Original languageEnglish (US)
Pages (from-to)607-613
Number of pages7
JournalJournal of Allergy and Clinical Immunology
Issue number3
StatePublished - Mar 2008
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology


  • Asthma
  • adult asthma
  • atopy
  • childhood asthma
  • epidemiology
  • inhaled corticosteroids
  • persistence
  • progression
  • remodeling
  • wheezing


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