The Dutch Hypothesis Revisited: Recent Evidence That Children Do Not Outgrow Asthma

Abstract

ABSTRACT

The phenotype termed "asthma" now appears to represent a heterogeneous group of genetic defects, and as with any genetic condition, one should not be expected to outgrow the underlying pathology. Though anecdotal experience supports the impression that children outgrow asthma, perhaps they only outgrow their pediatrician. The current review presents the evidence that abnormalities in these children persist that should perhaps be followed. Anatomic considerations are discussed that can account for the disappearance of wheezing in early childhood despite continued presence of inflammation. Long-term follow-up studies confirm the persistence of abnormal bronchoscopy and spirometry findings. Six risk factors are presented that have been proposed to help identify those individuals at risk of excessive lung function decline in later adulthood. Successful prevention by inhaled corticosteroids is discussed. The evidence favors that (1) outgrowing asthma can be a misnomer, (2) there is a subset of postviral wheezers not persisting past age 10 years, but there is also a sizable cohort of postwheezing children who still have asthma that needs to be followed, (3) many COPD patients could actually represent end-stage mild asthma, (4) screening of adults who have outgrown asthma should be done more often, (5) education and counseling should be done so that the patient knows the importance of follow-up, and (6) high-risk patients (identified by predictors of lung decline) might benefit from inhaled corticosteroids and yearly spirometry.