Padrões de sibilância respiratória do nascimento até o início da adolescência: coorte de Pelotas (RS) Brasil, 1993-2004

Abstract

Objective: To study the prevalence of wheezing patterns and their associations with independent variables. Methods: Cohort study of live births in 1993 in Pelotas, Brazil. A systematic subsample (20%) of the original cohort was evaluated at 6 months, 12 months and 4 years. At 10-12 years, 87.5% of the original cohort was contacted. Wheezing was categorized: transient, wheezing at 4 years but not at 10-12; persistent, wheezing at all evaluations; late-onset, wheezing at 10-12 years. Independent variables were analyzed: gender; skin color; family income; smoking/asthma during pregnancy; breastfeeding; respiratory infection/diarrhea (during the 1st year); family members with asthma/ allergy (at 4 years and at 10-12); physician-diagnosed rhinitis/eczema (at 10-12 years). Results: The subsample comprised 897 adolescents. Wheezing patterns were expressed as prevalence (95% CI): transient, 43.9% (40.7-47.2); persistent, 6.4% (4.8-8.0); and late-onset, 3.3% (2.2-4.5). The transient pattern was more common in children from low-income families, children breastfed for less time, children with a history of respiratory infections (during the 1st year) and children with asthma in the family (at 4 years). The persistent pattern was almost twice as common in males, in children whose mothers had asthma during pregnancy, in children with respiratory infections (during the 1st year) and in children with asthma in the family (at 4 and 10-12 years). The late-onset pattern was more prevalent among those with asthma in the family (at 10-12 years) and those diagnosed with rhinitis (at 10-12 years), being less prevalent among those reporting respiratory infections (during the 1st year) and those diagnosed with eczema (at 10-12 years). Conclusions: Knowledge of the associations of wheezing patterns allows us to adopt preventive and therapeutic measures.Keywords: Respiratory sounds; Asthma; Epidemiology; Hypersensitivity. ResumoObjetivo: Estudar a prevalência dos padrões de sibilância respiratória e suas associações com variáveis independentes. Métodos: Coorte de nascidos vivos, 1993, Pelotas (RS); subamostra sistemática de 20% da coorte original acompanhada aos 6 e 12 meses e 4 anos; aos 10-12 anos localizou-se 87,5% da coorte original. Definição dos padrões: transitório: chiado até 4 anos e ausência de chiado aos 10-12 anos; persistente: chiado em todos acompanhamentos; início tardio: chiado aos 10-12 anos. Variáveis independentes: gênero; cor da pele; renda familiar; fumo/asma na gravidez; amamentação; infecção respiratória/diarréia (1º ano); alergia e asma na família (4 e 10-12 anos); diagnóstico médico de rinite/eczema (10-12 anos). Resultados: O total da subamostra foi de 897 adolescentes. Prevalência (IC95%) dos padrões de sibilância: transitório 43,9% (40,7-47,2);persistente 6,4% (4,8-8,0); de início tardio 3,3% (2,2-4,5). O transitório foi mais freqüente em crianças de famílias de baixa renda, com menor duração da amamentação, relato de infecções respiratórias (1º ano) e história familiar de asma (4 anos); o persistente f...

Risk factors associated with wheezing in infants

“…In a Brazilian cohort study, family history of asthma assessed at four years of age was significantly associated with the pattern of transient and persistent wheezing. 5 Other studies have found this association 16---18 , in agreement with the Asthma Predictive Index (API), which has parental history of asthma as a major criterion for the diagnosis of asthma in children with recurrent wheezing. 19 The presence of six or more episodes of upper respiratory tract infections in the first year of life, with early onset (before three months of age), was a factor associated with wheezing in this study (Tables 1 and 3).…”

Risk Factors for Recurrent Wheezing in Infants

“…The reason for this gender difference is based on lower airway caliber male relative to the female gender 13 , this relationship, which is reversed as the child reaches adolescence.…”

“…Infants who have a family history of asthma 2,6,15 ,rhinitis 15 and allergic dermatitis have the greatest chance to present episodes of wheezing in the first 12 months of life, showing that heredity is an important risk factor for wheezing and asthma later 2,5,6,10,12,13 .…”

Prevalência de sibilância e fatores associados em crianças menores de 5 anos de Cuiabá, Mato Grosso, Brasil

“…No entanto, a prevalência de sibilância e de diagnóstico médico de asma no presente estudo está situada entre os valores mais altos considerando os limites de variação descritos na literatura nacional 2,3,10,17,18 .…”

“…Esses fatores podem estar relacionados tanto à provável atopia quanto a infecções. Dentre as doenças presentes na infância, as principais são as infecções respiratórias e estas se configuram como fator de risco para asma 10,17,18 , com destaque para o papel das infecções virais, que podem causar sibilância em graus variados 19,20,21 . As mães podem superestimar a gravidade da doença do filho, no entanto, é pouco provável que diga que o mesmo está doente quando de fato não está.…”