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Asthma Inception: Epidemiologic Risk Factors and Natural History Across the Life Course.

Author information

Affiliations

  • 1. Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
      Authors
    • Melén E 1
    (1 author)
  • 2. Department of Paediatrics and Child Health and South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
      Authors
    • Zar HJ 2
    (1 author)
  • 3. University Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Team of Environmental Epidemiology Applied to Development and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France.
      Authors
    • Siroux V 3
    (1 author)
  • 4. Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom.
      Authors
    • Shaw D 4
    (1 author)
  • 5. National Heart and Lung Institute, Centre for Paediatrics and Child Health, Imperial College London, London, United Kingdom.
      Authors
    • Saglani S 5
    • Bush A 5
    (2 authors)
    • Show all (10)

ORCIDs linked to this article

American Journal of Respiratory and Critical Care Medicine, 01 Sep 2024, 210(6):737-754
https://doi.org/10.1164/rccm.202312-2249so PMID: 38981012 

Review

Free full text available after 15 Sep 2025

Abstract 

Asthma is a descriptive label for an obstructive inflammatory disease in the lower airways manifesting with symptoms including breathlessness, cough, difficulty in breathing, and wheezing. From a clinician's point of view, asthma symptoms can commence at any age, although most patients with asthma-regardless of their age of onset-seem to have had some form of airway problems during childhood. Asthma inception and related pathophysiologic processes are therefore very likely to occur early in life, further evidenced by recent lung physiologic and mechanistic research. Herein, we present state-of-the-art updates on the role of genetics and epigenetics, early viral and bacterial infections, immune response, and pathophysiology, as well as lifestyle and environmental exposures, in asthma across the life course. We conclude that early environmental insults in genetically vulnerable individuals inducing abnormal, pre-asthmatic airway responses are key events in asthma inception, and we highlight disease heterogeneity across ages and the potential shortsightedness of treating all patients with asthma using the same treatments. Although there are no interventions that, at present, can modify long-term outcomes, a precision-medicine approach should be implemented to optimize treatment and tailor follow-up for all patients with asthma.

Full text links 

Read article at publisher's site: https://doi.org/10.1164/rccm.202312-2249so

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Funding 

Funders who supported this work.

European Union (1)

Lung Foundation Netherlands (1)

NHLBI NIH HHS (2)

NIAID NIH HHS (2)

NIH (3)

NIH HHS (3)

Zon VICI (1)