1. NHLBI Childhood Asthma Management Program (CAMP): What Have We Learned? CAMP began as a multicenter (8 clinical + 1 data coordinating center) clinical trial to determine the effect of antiinflammatory therapy on lung growth in children 5-12 years old (N=1046) with persistent mild to moderate asthma. It is now a longitudinal cohort follow-up study to determine the natural history of childhood asthma into adulthood. We currently are actively following 83% of the original cohort. Albuquerque Baltimore Boston Denver San Diego Seattle St Louis Toronto Johns Hopkins DCC

2. CAMP and CAMPCS Routine Care Randomize Treatment Phase Transition Phase 5 visits 3 visits per year 2 visits Discontinue Study Rx 2 - 4 months 4 – 6 years 4 months Screening & Baseline Phase 1- 4 visits per year 13 years Follow- up Phases Enroll in CAMPCS, Rx directed by PCP per NAEPP Ned Bud Plbo 1994

3. Primary outcomes (123 peer-reviewed publications) Clinical Trial ICS improved bronchial hyper- responsiveness, symptoms, exacerbations, and healthcare utilization but not lung growth. ICS reduced linear growth but not BMD or HPA-axis, or cause cataracts or affect psychological development or neurocognitive functioning. Continuation Study Once discontinued all positive benefits lost (didn’t cure asthma). Lung growth exhibiting different patterns, unaffected by therapy. Linear growth still less in ICS group, bone-mineral accretion reduced by bursts of oral steroids but not ICS use. No increase in catarracts.

4. Age (yr) 01020304050607080 50 25 Reduced Growth Early Decline FEV 1 (% normal level at age 20) Normal Rapid Decline Rationale for Continuation of CAMP 100 75

5. Secondary outcomes (123 peer-reviewed publications) Genetics (60%) Beta-adrenergic response not related to Arg/Gly beta receptor polymorphisms. ICS response partially genetically determined, including growth suppression. Numerous papers on association of genes with asthma and various asthma characteristics. Others In utero smoke exposure impairs response to ICS. Low serum VitD levels associated with increase severe exacerbations. Correlations with HRCT structural findings and patterns of lung function decline. Post pubertal females have more severe bronchial responsiveness than males.