Prognosis

Asthma is a chronic illness and source of significant morbidity and mortality. Longitudinal data suggest that the pattern of asthma that is present in late childhood typically persists through to adulthood.[4]

See Asthma in adults.

Severe asthma symptoms (4.3% age 6-7 years; 4.9% age 13-14 years), exercise-associated wheeze (6.4% age 6-7 years; 18.2% age 13-14 years), and nocturnal cough (24.8% age 6-7 years; 30.3% age 13-14 years), which are indicative of poor control, remain prevalent symptoms in children.[4] Poorly controlled asthma and recent exacerbations are risk factors for further exacerbations and increased morbidity.[1]

Some cohort studies have found that the risk of chronic obstructive pulmonary disease in later life is greater in those with a past history of childhood persistent asthma.[245][246][247]​​

Mortality

The life expectancy of those with well-controlled childhood asthma is equivalent to that of the general population. In the US, the estimated overall mortality rates for asthma in children are:[6]​ 

  • 2.0 per million overall for age <18 years, but higher among males (2.4 per million) than among females (1.6 per million)

  • 1.4 per million among children ages 0-4 years

  • 2.4 per million among children ages 5 -11 years

  • 2.0 per million among children ages 12-17 years

There is significant variability by race/ethnicity in the US:[6]

  • 1.0 per million among white non-Hispanic children

  • 1.4 per million among Hispanic children

  • 7.7 per million among black non-Hispanic children

Remission

Remission is possible either on treatment (ICS, biologics, allergen immunotherapies) or off treatment.[1]​[248]

Patients meeting the following criteria over a 12-month period (including those receiving monoclonal antibody therapy) may be considered in remission:[249]

  • No exacerbations

  • No missed work or school

  • Stable and optimized pulmonary function results on ≥2 measurements

  • Continued use of controller therapies, only at low-medium dose of ICS, or less

  • Asthma Control Test >20, Asthma Impairment and Risk Questionnaire <2, or Asthma Control Questionnaire <0.75 on ≥2 measurements

  • Symptoms requiring 1-time reliever therapy no more than once a month

It should be noted that remission is not cure, and that asthma may recur later in life.[1] 

This is a topic of ongoing debate.

Impact of corticosteroid therapy

The benefits of inhaled corticosteroid (ICS) use for asthma control are generally considered to outweigh the potential adverse effects.[161] 

Regular use has negative effects on short-term linear growth, particularly at higher doses. A transient slowing in height velocity may occur and affect final adult height.[168][250][251]​​​​ Prospective cohort studies indicate that early life exposure to ICS, before age 6 years, is associated with reduced height but no change in bone density during continued therapy.[172]​ The benefit attributable to use of ICS may exceed the potential risk of a relatively small suppression in linear growth in children with asthma. [161][173]

Oral corticosteroid use is more frequently associated with hypothalamic-pituitary axis suppression, growth retardation, and weight gain.[179][180]​ Adrenal insufficiency is a potential complication with high cumulative doses of ICS.[174][175]

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