To determine predictors of adult asthma remission in an ethnically diverse population of patients with mild to moderate persistent childhood asthma.

The study included 879 participants from The Childhood Asthma Management Program, a randomized, placebo-controlled trial of inhaled anti-inflammatory treatments for mild to moderate persistent asthma in children followed by an additional 13 years of detailed longitudinal follow-up, and in which children had asthma remission outcomes available at their first follow-up visit on or after age 18 years.

A longitudinal study was performed with 879 participants from The Childhood Asthma Management Program (enrolled from December 1993 to September 1995) who had asthma remission outcomes available at their first follow-up visit on or after age 18 years. A strict definition was used to define asthma remission in early adulthood, including the absence of symptoms, exacerbations, and medication use as well as normal lung function, including normal airway responsiveness (defined as a negative methacholine challenge result). Predictors were identified from baseline measures by using multivariate logistic regression, and the probability of remission was modeled by using decision tree analysis.

By adulthood, 26.0% of 870 participants were in clinical remission, and of 741 participants who had bronchoprovocative testing, 15.0% were in strict remission. The greatest predictor of asthma remission was the degree of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) ratio impairment, with a majority of boys and girls with baseline FEV1/FVC ratios of 90% or greater who outgrew their disease. Decreased airway responsiveness was also a predictor, and the combination of normal FEV1/FVC ratio, airway hyperresponsiveness, and blood eosinophil count at baseline yielded >80% probability of remission by adulthood.

Investigators in the study found that a substantial minority (15%–26%) of children with mild to moderate persistent childhood asthma will have disease remission by adulthood. Clinical predictors of asthma remission, including baseline lung function, are prognostic indicators and can be seen from an early age.

This is the first comprehensive study to yield prognostic strata related to lung function measures in a multiethnic population with detailed longitudinal follow-up. Consistent with other studies is greater lung function, and reduced airway obstruction and hyperresponsiveness are associated with better asthma prognosis. These findings provide some encouragement for families dealing with childhood asthma and support the use of baseline spirometry in childhood asthma as an important prognostic measure.