Outgrowing Asthma: Is Remission Possible?
WebMD discusses how common asthma is in children and which kids are more likely to outgrow it.
At 14, Alyssa Flanagan’s asthma symptoms all but disappeared.
Since the age of 4, she had been hospitalized a few times each year -- once
in the intensive care unit - when her colds turned into coughing, wheezy
pneumonias. Asthma loomed large in her life.
“The simplest explanation is that I’ve outgrown it, or for some reason,
there was an immune trigger that’s not present anymore,” says Flanagan, now a
30-year-old medical resident at the University of Illinois-Chicago.
Flanagan says she’s aware her asthma could flare again. Even if symptoms go
underground, they can resurface in adulthood.
Why Flanagan is, so far, among the lucky ones is something of a medical
mystery. Without a long-term epidemiological study of young asthmatics in the
U.S., it’s impossible to determine who might go into remission, says Gary
Rachelefsky, a professor of allergy and immunology at UCLA.
WebMD went to a few experts to shed light on the subject.
If a child no longer has asthma symptoms, can you assume the asthma is gone, too?
Kids may become asymptomatic, but the “chronic stuff” in their lungs
probably doesn’t go away, says Derek K. Johnson, a pediatric allergist in
Fairfax, Va. Only a biopsy of lung tissue would offer certainty about the state
of a person’s airways.
“To follow changes (that occur in a person’s asthma), you need to look at it
on a microscopic level. It’s not something we do routinely,” says Johnson, the
former director of the division of allergy and clinical immunology at Temple
University Children’s Medical Center in Philadelphia.
Why do asthma symptoms disappear for some kids and not others?
Some working theories:
- As a child gets bigger, so do the airways in his lungs. Inflammation of
airways, an asthma hallmark, could go on unnoticed, Johnson says.
- Children who wheeze only when they have a cold or other upper respiratory
virus tend to improve with time, he says.
- Children who are sensitive to allergens from a young age tend not to
improve, Rachelefsky says. His observation is backed up by findings from a
nine-year study of more than 1,000 asthmatic children that found fewer
allergy-related antibodies in those who became symptom-free.
- Children with eczema, a skin disorder characterized by itchy rash, or a
family history of asthma are likelier to have lasting asthma symptoms.
- The more severe the asthma past the age of 5, the likelier symptoms will
continue, with or without allergies, Rachelefsky says.
How do I know if my child really does have asthma?
A doctor's work-up will start with a medical history including symptoms
(such as wheezing, coughing, shortness of breath) and family history. A
physical exam will also be done. Pulmonary function testing with spirometry can
provide information about lung function and severity of the asthma. A chest
X-ray may be ordered to help visualize the lungs. Allergy testing can be done
to determine if allergies play a role in symptoms. Additional tests may be done
to investigate other causes of symptoms.