© 2006 American Thoracic Society
Does Most Asthma Really Begin during the Preschool Years?From the Authors:Dr. Hahn raises an important point regarding our recent article (1), which deserves clarification. As he notes, we state in the introduction that it now seems established that the majority of cases of persistent asthma begin during the preschool years. Perhaps better would have been "by the age of six" or "by the first grade," which our data strongly support. Indeed, our conclusion was more precise in stating that both lung function characteristics in early infancy and events occurring during the first six years of life determine the expression of asthma and the level of lung function that will be achieved during childhood and into early adult life. We agree that of those children with current wheeze at age 16, only 40% wheezed in the first three years of life; however, 68% were wheezing by age 6. Further, of those with frequent wheezing at age 16, 79% were transient, persistent or late onset wheezers. Some of these children likely began wheezing in their fourth or fifth year of life, but certainly all had wheezed by the first grade. In our paper, we did not address the prevalence or immune or physiologic characteristics of asthma in adulthood. We recognize that there is a continued low stable incidence of asthma during the adult years as reported by our colleagues (2). We are continuing to follow our cohort and will evaluate the nature of incident asthma in adulthood as we have done in relation to obesity and puberty (3, 4). Nonetheless, our data clearly demonstrate that the majority of wheeze occurring during adolescence began by age 6. More importantly, we have been able to demonstrate that deficits in lung function related to asthma, as described in other longitudinal population studies (5, 6), appear to occur prior to age 6 and remain stable through adolescence. As noted in our paper, we are concerned that even the transient wheeze group, demonstrating diminished lung function, but rates of atopy similar to the never-wheeze group, may be at risk for later pulmonary disease (7).
University of Arizona, Tucson, Arizona FOOTNOTES Conflict of Interest Statement: W.J.M. is Chair of the Epidemiology Study of Cystic Fibrosis sponsored by Genentech, Inc. He received $7,000 in 2005 for this activity. D.A.S. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript. F.D.M. received $9,500 in 2005 from Merck for serving as a member on the Merck Respiratory Scientific Advisory Board. In 2004, Merck provided him with $5,000 as honorarium for presenting at the Pediatric Respiratory Congress in Korea as well as reimbursing him for his travel expenses, totaling $8,482. In August 2005, he traveled to South Africa for the Allergy Society of South Africa Annual Meeting, which was partially sponsored by Merck South Africa. For this, his airline ticket was purchased by Merck directly and he received a small honorarium totaling $2,500. In September 2005, he participated in a Pfizer Advisory Board and received honorarium payment of $3,000. In 2005 he provided consultation services for Genentech teleconference. For these services, he was compensated $300. Although he is a member of the Pulmonary Advisory Board for Xolair, he has not yet participated in any meetings and has not received any financial support related to this board. Similar to his participation in the Genentech Advisory Board, he is a member of the AltanaPharma Global Advisory Board for Roflumilast but has not yet attended any meetings or provided any services related to this board. No monies have been received from AltanaPharma. He has not participated in any events or received any financial contribution from AstraZeneca since 2003. In 2003, he presented a talk in Phoenix, AZ at an event sponsored by GlaxoSmithKline. For his lecture, he received an honorarium of $1,500. No additional participation or financial relationship has existed in the years following. The small grants received from commercial entities in the name of Dr. Martinez are deposited directly into University Foundation accounts used for the sole purpose of continuing education at the University of Arizona, Arizona Respiratory Center. These are listed on Dr. Martinez's disclosure because he is the Director of the Center, and therefore, the responsible party. There is no direct financial relationship between Dr. Martinez and the financial sponsors of the recipient education programs. The pending patent is in direct relation to a grant funded by the National Institutes of Health. No commercial entity is currently associated. REFERENCES
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