Asthma is never outgrown. Asthma is a lifelong diagnosis. Symptoms of asthma, however, can become absent for long periods of time, on the order of years in many cases, and thus lead to the impression that a child has out-grown the disease. The state of baseline hyperreactivity (discussed in Question 12) that defines asthma never disappears. Many boys and girls who have asthma during their early childhood years do indeed become symptom-free as adolescents, and even beyond.
It is easy to then erroneously equate the disappearance of asthma symptoms over time with “outgrowing” asthma. Contemporary medical thinking views the phenomenon of disappearing asthma as a state of very prolonged asthma remission during which symptoms abate. Although epidemiologic studies do confirm the phenomenon, too many general pediatricians falsely reassure parents that their child will “outgrow” their asthma symptoms and the need for asthma medication by young adult-hood.
The reason may be partly related to the doctor’s personal clinical experience of treating youngsters with asthma. As you can easily imagine, a 34-year-old father of two, who begins to wheeze again for the first time since he was 14 years old, generally does not call his former pediatrician to report this medical development!
If you ask an asthma specialist if your son’s asthma symptoms will decrease, increase, or disappear with the passage of time, a realistic response might be, “I don’t know, since "I cannot predict in advance what will happen to your particular child’s asthma.” Certain clinical clues do appear to indicate a greater likelihood of asthma symptoms decreasing over time.
There seems to be a greater likelihood that a child will stop experiencing asthma symptoms with the passage of time if they have no parental history of asthma and allergy, if their symptoms of cough or wheezing began early in life, and if their primary trigger was a respiratory tract infection. Many children with these characteristics are free of asthma symptoms within the first decade of life.
Ongoing symptomatic asthma requiring medicine has on the other hand, been associated with the presence of clinical symptoms of both asthma and eczema; wheezing that develops in the absence of infection; older age of symptom onset; asthma and/or allergy in the parents, especially the mother; and physician-diagnosed allergic rhinitis in a child who has experienced previous episodes of asthma.
Although we all have a tendency to want information on what to expect or on what lies ahead, particularly for our children and their health, there is no way to accurately predict the course of asthma symptoms in any individual over time. The results of studies, as described above, may help your child’s doctor hazard an educated guess, but my perspective is to instead refocus on the present and obtain the best asthma care for your child.
Learn about asthma—an excellent step in that regard—and ensure that your child’s asthma is controlled through adherence to a comprehensive asthma treatment plan. We all want our children to be as healthy as they can possibly be, and we want them to grow into happy and fulfilled adults. Well-controlled asthma is not a barrier to any of those goals!