Incidence and remission of asthma: A retrospective study on the natural history of asthma in Italy

De Marco, R.; Locatelli, F.; Cerveri, I.; Bugiani, M.; Marinoni, A.; Giammanco, G.; Accordini, S.; Verlato, G.; Zanolin, E.; Buriani, O.; Carrozzi, L.; Dallari, R.; Ginesu, F.; Poli, A.; Struzzo, P.; Cavallini, R.; Saletti, C.; Cellini, M.; Faustini, M.; De Togni, A.; Carolei, A.; Montomoli, C.; Villani, S.; Comelli, M.; Ponzio, M.; Grassi, M.; Rezzani, C.; Casali, L.; Zoia, M. C.; Corsico, A.; Colato, S.; Moscato, G.; Perfetti, L.; Viegi, G.; Pistelli, F.; Di Pede, F.; Paggiaro, P. L.; Santolicandro, A.; Giovannetti, P.; Pirina, P.; Ostera, S.; Pinna, G. P.; Farre, A.; Imparato, S.; Turrini, E.; Foglia, M.; Pignato, S.; Rotondo, A.; Cuspilici, A.; Piccioni, P.; Carosso, A.; Arossa, W.; Caria, E.; Castiglioni, G.; Migliore, E.; Romano, C.; Fabbro, D.; Ciccone, G.; Magnani, C.; Dalmasso, P.; Bono, R.; Gigli, G.; Giraudo, A.; Brussino, M. C.; Bucca, C.; Rolla, G.; Orefice, U.; Schneider, M.; Chittaro, F.; Peresson, D.; Zanolin, M. E.; Cazzoletti, L.; Battisti, L.; Pattaro, C.; Dorigo, N.; Cantarelli, S.; Ciresola, D.; Lo Cascio, V.; Olivieri, M.; Ferrari, M.; Biasin, C.; Lauriola, P.; Danielli, G.; Sesti, D.; Ghigli, E.; Natale, P.; Grosa, M.; Tacconi, A.; Frontero, P.; Salomoni, A.

doi:10.1067/mai.2002.125600

Background: The knowledge of the natural history of asthma from birth to adulthood could provide important clues for its cause and for the understanding of epidemiologic findings. Objective: This study is aimed at assessing the incidence and remission of asthma from birth to the age of 44 years by using data from 18, 873 subjects involved in a large, nationally representative, cross-sectional study carried out in Italy from 1998 through 2000. Methods: The onset of asthma was defined as the age at the first attack, and remission was considered present when a subject was neither under treatment nor had experienced an asthma attack in the last 24 months. Person-years and survival techniques were used for the analysis. Results: The average annual incidence rate for the 1953 to 2000 period was 2.56/1000 persons per year. Incidence peaked in boys less than 10 years of age (4.38/1000 persons per year) and in women 30 years of age or older (3.1/1000 persons per year) and showed a generational increase (incident rate ratio = 2.63 and 95% CI = 2.20-3.12 for 1974-1979 vs 1953-1958 birth cohort). The overall remission rate was 45.8% (41.6% in women and 49.5% in men, P <.001). Asthmatic patients in remission had an earlier age at onset (7.8 vs 15.9 years, P <.001) and a shorter duration of the disease (5.6 vs 16.1 years, P <.001) than patients with current asthma. The probability of remission was strongly (P <.001) and inversely related to the age at onset (62.8% and 15.0% in the <10- and >20-years age-at-onset groups, respectively). Conclusion: With respect to its natural history, asthma presents 2 different forms: early-onset asthma, which occurs early in childhood, affects mainly boys, and has a good prognosis, and late-onset asthma, which generally occurs during or after puberty, mainly affects women, and has a poor prognosis. The minority of patients with early-onset asthma who do not remit represents more than 35% of patients with current asthma in the general young adult population.