Early-life risk factors for development of asthma from 8 to 28 years of age: a prospective cohort study

Background The objective was to estimate the incidence rate of asthma from age 8 to 28 years and evaluate early-life risk factors for asthma onset at different ages. Methods In 1996, within the Obstructive Lung Disease in Northern Sweden (OLIN) studies, a cohort of 3430 schoolchildren (97% of invited) was recruited at age 8 years to a prospective study about asthma. The cohort was followed annually from age 8 to 19 years and at 28 years by questionnaire surveys (67% of the original cohort participated). Asthma was categorised as never-asthma, onset age <= 8 years, onset age 9-13 years, onset age 14-19 years or onset age >19 years. Results Of the 3430 individuals in the cohort, 690 (20.1%) reported asthma in any survey. The average incidence rate was 10.0/1000 per year at <= 18 years, 11.9/1000 per year at 9-13 years, 13.3/1000 per year at 14-19 years and 6.1/1000 per year at >19 years. The incidence was higher among boys until age 10 years, but from age 15 years, it became higher among girls. Family history of asthma, allergic sensitisation and breastfeeding <3 months were associated with asthma onset throughout the study. Low birthweight, maternal smoking during pregnancy, severe respiratory infection, rhinoconjunctivitis and eczema were associated with asthma onset <= 18 and 9-13 years. Conclusions The incidence of asthma was high during childhood and the teenage period, and decreased substantially during young adulthood. Early-life factors were associated with asthma onset throughout childhood but had also a lasting effect on asthma incidence until adulthood.