Allergy Asthma Respir Dis.  2013 Mar;1(1):11-19. 10.4168/aard.2013.1.1.11.

Long-term asthma remission during adolescence

Affiliations
  • 1Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. kohyy@plaza.snu.ac.kr

Abstract

Asthma is a heterogeneous disorder with a variable course, characterized by episodes of cough, wheezing and shortness of breath, reversible airflow limitation, and bronchial hyperresponsiveness (BHR). It begins early in life in many subjects, and it is well recognized that over 50% of asthmatic children go into long-term clinical remission, defined as the complete absence of asthmatic symptoms and no asthma medication for at least 24 months, during adolescence. Several studies have shown spirometric abnormalities and BHR during clinical remission. It is unknown whether these functional abnormalities, which are supposed to be indicative of asthma severity with respect to symptomatic asthma, reflect persistent airway inflammation or merely indicate residual airway damage or are related to another mechanism such as a familial predisposition. It is likely that the nature of BHR in asthma remission is not same as that in symptomatic asthma. We have shown that the former condition is associated with lower levels of blood eosinophils and eosinophilic cationic protein, a lower degree of bronchial responsiveness to exercise, and a more common formation of plateau on the dose-response curve to high-dose inhaled methacholine (i.e., limited maximal airway narrowing), compared to the latter condition. It is still controversial whether BHR in adolescents with asthma remission is reduced by inhaled corticosteroids. Better understanding of the mechanisms that lead to asthma remission, especially that seen during adolescence, is likely to lead to significant advances in our understanding of asthma pathogenesis, and should provide insights into how remission might be induced with therapy. We still have minimal understanding of the mechanism underlying BHR in adolescents with asthma remission. Elucidation of this mechanism would be an important step towards new perspectives that see remission as the next therapeutic frontier in asthma.

Keyword

Adolescence; Asthma; Bronchial hyperresponsiveness; Clinical remission

MeSH Terms

Adolescent
Adrenal Cortex Hormones
Asthma
Child
Cough
Dyspnea
Eosinophils
Humans
Inflammation
Methacholine Chloride
Respiratory Sounds
Adrenal Cortex Hormones
Methacholine Chloride
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