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Persistence of Asthma Symptoms during Adolescence

Role of Obesity and Age at the Onset of Puberty

Arizona Respiratory Center, University of Arizona, College of Medicine, Tucson, Arizona

Correspondence and requests for reprints should be addressed to Fernando D. Martinez, M.D., Arizona Respiratory Center, University of Arizona, 1501 North Campbell Avenue, P.O. Box 245030, Tucson, AZ 85724–5030. E-mail: fernando{at}resp-sci.arizona.edu

Little is known about rates and predictors of remission of childhood asthma after the onset of puberty. We used data collected at ages 6, 8, 11, 13, and 16 years from the Tucson Children's Respiratory Study, a population-based birth cohort. The onset of puberty was defined as the age of appearance of the first pubertal signs as reported by parents. Information on wheezing both before and after onset of puberty (mean ± SD follow-up from onset of puberty, 4.2 ± 1 year) was available for 781 children. Of these, 166 had asthma (either frequent wheezing or a physician-confirmed diagnosis plus any wheezing) in at least one survey before puberty. In this group, 58% of the children (97 of 166) reported the presence of wheezing after the onset of puberty (unremitting asthma). In contrast, only 30% (39 of 131) of the children with infrequent wheezing before puberty experienced wheezing episodes after the onset of puberty (unremitting wheezing). In addition to frequent wheezing before puberty, obesity, early onset of puberty, active sinusitis, and skin test sensitization were significant and independent predictors of unremitting asthma after the onset of puberty. Our findings from a population-based longitudinal cohort challenge the commonly held view that asthma usually remits during adolescence.

Key Words: asthma • wheezing • obesity • puberty

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