Outgrowing Asthma: Is Remission Possible?

WebMD discusses how common asthma is in children and which kids are more likely to outgrow it.

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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.

Continued

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.

If my child no longer has asthma symptoms, could it be that he was misdiagnosed with the disease?

Perhaps. Rachelefsky says a lot of children diagnosed with asthma don’t have it and many asthmatics go undiagnosed.

“Spirometry is standard, but many physicians in primary care practices don’t have a spirometer. They diagnose sinusitis as asthma and mistake asthma for esophageal reflux,” he says.

But for children under the age of 2, it is difficult to do spirometry to test for asthma. When a child is that young, providing a diagnosis “is an imperfect science,” says Reynolds J. Panettieri Jr., a pulmonologist with the University of Pennsylvania.

“If you have true asthma, you don’t outgrow it,” so young children who are wheezing from a viral infection that hangs around for a long time may not have asthma but “twitchy” or hypersensitive airways that are a holdover from the virus, he says.

Johnson says, even if a child is too young for standard testing, “It’s better to err on the side of caution and treat kids whether they have asthma or not. The benefits are great,” he says.

Why do more boys outgrow asthma than girls?

Although a recent study found that boys were more likely than girls to outgrow asthma, Rachelefsky says there isn’t enough research to make any conclusions about gender and the progression of asthma.

Panettieri says more girls develop asthma after the onset of puberty; boys develop it before.

“It’s not that boys outgrow it, but now there are more women with it,” he says.

Some studies have suggested that hormonal differences may factor in to a higher prevalence of adult asthma in women.

Continued

If a child has asthma and goes into remission, are they more susceptible to respiratory issues later in life?

Usually, says Johnson.

An asthmatic may have more breathing trouble with colds as adults, “and that’s why it’s so important for patients to understand what uncontrolled asthma is, so in the future they know how to seek treatment,” he says.

Is there any way of altering the course of asthma in young children?

“It’s not really the case that intervention changes the course of asthma. But medicines have gotten so safe that we can pretty much neutralize symptoms indefinitely in the majority of people with asthma,” Johnson says. Uncontrolled asthma leads to emergency room visits, absenteeism from school, and missed opportunities for social and athletic interchange, he says.

Rachelefsky adds, “The goal of asthma treatment is control of the disease to allow someone to have a normal life, knowing that it may not prevent the natural history of the disease. People should concentrate on the right diagnosis and treatment.”

WebMD Feature Reviewed by Louise Chang, MD on August 13, 2009

Sources

SOURCES:

Alyssa Flanagan, medical resident, University of Illinois-Chicago.

WebMD Medical Reference: "Asthma in Children & Infants."

Gary Rachelefsky, MD, director, Center for Asthma, Allergy and Respiratory Diseases.

Derek K. Johnson, MD, medical director, Fairfax Allergy, Asthma and Sinus Clinic.

Ronina Covar, MD, American Academy of Allergy, Asthma, & Immunology Annual Meeting, San Antonio, March 18-22, 2005.

News release, National Jewish Medical and Research Center, Denver.

Spahn, J.D. Journal of Allergy Clinical Immunology, March 2008; vol 121: pp 548-557.

Reynold A. Panettieri, Jr, MD.

WebMD Health News: "Boys More Likely to Outgrow Asthma."

Gender Medicine, 2007; 4 Suppl B: pp S133-S146. 

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