The prognosis of severe bronchial asthma in childhood on the basis of late reexaminations.

Abstract

Four hundred and forty one patients treated for asthma between 1954 and 1978 were reexamined. Their age ranged from 15 to 36 years at the time of reexamination. To regard a case as severe, at least four factors out of the following six had to be present: 1. Attacks more frequent than one every week; 2. attacks lasting for more than one day; 3. six or more hospitalizations; 4. absence from school exceeding one month per school-year; 5. drop-out from school for at least one school-year; 6. steroid treatment for more than one week. 59 patients (13.3%) fulfilled the criteria. The sex ratio within the severe group was 1:1 although there was a male preponderance of all asthmatics. The recovery rate for the severe group was lower (40.6%) than for all patients (75.0%). Prognosis was less favourable in female than in male patients. In the severe group the disease appeared earlier, eczema during infancy occurred more frequently and allergic disorders had a higher incidence in the family than in the group as a whole. Chest deformities were observed in 48.7% of severe patients while its incidence was only 18.6% for all patients with asthma. Acetylcholine-induced bronchial hyperactivity was more frequent in the severe patients than in all patients irrespective of the degree of severity while the prevalence of exercise induced asthma showed no relationship to the degree of severity. Among the severe cases 31% failed to cope with a standardized physical load.