• Neema Izadi, David Baraghoshi, Douglas Curran-Everett, Robert S Zeiger, Stanley J Szefler, Ronina A Covar, and Childhood Asthma Management Program Research Group.
• Children's Hospital Los Angeles Department of Pediatrics, 337885, Division of Clinical Immunology & Allergy, Los Angeles, California, United States; nizadi@chla.usc.edu.
• Am. J. Respir. Crit. Care Med. 2021 May 24; 204 (7): 776787776-87.

RationaleAsthma severity in children generally starts mild but may progress and stay severe for unknown reasons.ObjectivesIdentify factors in childhood that predict persistence of severe asthma in late adolescence and early adulthood.MethodsThe Childhood Asthma Management Program is the largest and longest asthma trial in 1041 children aged 5-12 years with mild to moderate asthma. We evaluated 682 participants from the program with analyzable data in late adolescence (age 17-19) and early adulthood (age 21-23).MeasurementsSevere asthma was defined using criteria from the American Thoracic Society and the National Asthma Education and Prevention Program to best capture severe asthma. Logistic regression with stepwise elimination was used to analyze clinical features, biomarkers, and lung function predictive of persistence of severe asthma.Main ResultsIn late adolescence and early adulthood 12% and 19% of the patents had severe asthma, respectively; only 6% were severe at both time periods. For every 5% decrease in post bronchodilator FEV1/FVC in childhood, the odds of persistence of severe asthma increased 2.36-fold (95% CI: 1.70-3.28; p <0.0001), for participants with maternal smoking during pregnancy odds of persistence of severe asthma increased 3.17-fold (95% CI: 1.18-8.53, p=0.02). Reduced growth lung function trajectory was significantly associated with persistence of severe asthma compared to normal growth.ConclusionsLung function and maternal smoking during pregnancy were significant predictors of severe asthma from late adolescence to early adulthood. Interventions to preserve lung function early may prevent disease progression.

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