Asthmatic/wheezing phenotypes in preschool children: Influential factors, health care and urban-rural differences

Kutzora, Susanne; Weber, Anna; Heinze, Stefanie; Hendrowarsito, Lana; Nennstiel-Ratzel, U; Mutius, Erika von; Fuchs, Nina; Herr, Caroline

doi:10.1016/j.ijheh.2017.12.001

Cited by 16 publications

(12 citation statements)

References 27 publications

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“…The respiratory system gradually undergoes development with age which may be an important reason for the decrease in the number of wheezing episodes [17]. In addition, our findings echo the previous reports that the risk factors of wheezing also show phenotypic variability [18, 19]. A large population-based cohort in the UK showed that episodic viral wheeze decreased with age, but multiple trigger wheeze (mainly due to exercise or aeroallergen-associated wheeze) increased [20].…”

Section: Discussionsupporting

confidence: 88%

Risk factors and prognosis of recurrent wheezing in Chinese young children: a prospective cohort study

Guo¹,

Zhu²,

Wang³

et al. 2019

Allergy Asthma Clin Immunol

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Background Nearly all the investigations into the risk factors for wheezing and asthma were conducted in developed countries with a high prevalence rate of asthma and allergy, but the studies in developing countries are limited. In this study, we aimed to investigate the risk factors for different wheezing phenotypes in Chinese young children and to explore the prognosis of recurrent wheezing. Methods This cohort study contained the recruitment stage and the follow-up stage conducted by phone questionnaire survey. According to the information collected at the follow-up for wheezing episodes and remission age, our cohort was divided into transient wheezing, persistent wheezing and late-onset wheezing. The wheezing symptoms and potential risk factors were compared between these three wheezing groups. Results From the initial 109 participants, 78.0% completed the follow-up survey. The frequency of current wheezing at followup was significantly reduced in all three groups compared to the recruitment stage ( p < 0.01). We observe a trend that the rhinovirus (RV) and respiratory syncytial virus (RSV) infection rates were higher in the persistent wheezing group, and the overall infection rates appear to be the lowest in late-onset wheezing group at recruitment. At follow-up stage, the rates of rhinitis ever and current rhinitis were both higher in the persistent wheezing (63.0%, 50.0%) and late-onset wheezing groups (88.2%, 58.8%), compared to the transient wheezing group (14.3%, 14.3%). The incidence of current wheezing episodes increased cumulatively if the participant had concomitant risk factors of rhinitis ever, aeroallergens sensitization at recruitment, either alone or together with previous RV infection at the time of recruitment. Conclusion While the incidence of wheezing declined overall with age, but in addition to transient wheezers, additional subsets of children manifest persistent wheeze or late onset wheeze, and moreover the risk factors for wheezing display phenotypic variability between these subgroups. Rhinitis ever and aeroallergens sensitization, either alone or together with previous RV infection, were the most significant predictors for persistent wheezing in children in an eastern environment, such as in China.

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Section: Discussionsupporting

confidence: 88%

Risk factors and prognosis of recurrent wheezing in Chinese young children: a prospective cohort study

Guo¹,

Zhu²,

Wang³

et al. 2019

Allergy Asthma Clin Immunol

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“…In Portugal, asthmatic children (0–17 years old) from rural areas were less likely to report using any inhaled therapy than children from urban areas [20]. In Bavaria (Germany), asthma medication intake among pre-schoolers was significantly higher in rural compared with urban areas [19]. Our results regarding prevalence of purchase are consistent with those shown in the Bavarian study.…”

Section: Discussionsupporting

confidence: 86%

“…So far, only two studies have specifically looked at the geography of asthma medication use and described urban vs rural differences in asthma symptoms and medication use in children. Although both studies showed higher prevalence of symptoms in urban children, their results for medication use are inconsistent [19, 20]. In Portugal, asthmatic children (0–17 years old) from rural areas were less likely to report using any inhaled therapy than children from urban areas [20].…”

Section: Discussionmentioning

confidence: 99%

“…In this regard, previous research suggests that the prevalence of pre-school wheezing, the risk of asthma diagnosis, and that of the use of medication for airway-related symptoms may differ between urban and rural environments. While studies comparing urban and rural prevalence of respiratory symptoms in pre-schoolers show a higher prevalence and risk of asthma diagnosis in urban areas [18, 19], the few studies investigating differences in the use of asthma medication show inconsistent results [19, 20]. A potential explanation for these inconsistencies may be the differences in health care access or in medical practice across countries or regions.…”

Section: Introductionmentioning

confidence: 99%

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Geographies of asthma medication purchase for pre-schoolers in Belgium

Trabelsi¹,

Casas

Nemery

et al. 2019

Respir Res

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“…This is an important limitation since urban-rural differences in preschool wheeze phenotypes have been previously reported. 37 We were also unable to directly compare household measures of socioeconomic status in the present study, so it is unclear if the racial disparities noted in our latent classes were attributable to modifiable factors such as economic hardships and other environmental variables such as indoor allergen exposure that impact asthma disease manifestation and asthma-related healthcare utilization. [54][55][56][57] However, the fact that more nonHispanic Black children were represented in latent class 3 (sensitization with tobacco smoke exposure), does support a prior study demonstrating nearly two-fold higher odds of secondhand smoke exposure in Black and Puerto Rican/Hispanic children compared to non-Hispanic White children.…”

Section: Discussionmentioning

confidence: 88%

Phenotypes of Recurrent Wheezing in Preschool Children: Identification by Latent Class Analysis and Utility in Prediction of Future Exacerbation

AsthmaNet

2019

The Journal of Allergy and Clinical Immunology: In Practice

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Background-Recurrent preschool wheezing is a heterogeneous disorder with significant morbidity, yet little is known about phenotypic determinants and their impact on clinical outcomes. Objective-Latent class analysis (LCA) was used to identify latent classes of recurrent preschool wheeze and their association with future exacerbations and inhaled corticosteroid (ICS) treatment response. Methods-Data from five clinical trials of 1,708 children age 12-71 months with recurrent wheezing were merged. LCA was performed on 10 demographic, exposure and sensitization variables to determine the optimal number of latent classes. The primary outcome was the annualized rate of wheezing exacerbations requiring systemic corticosteroids during the study intervention period; the secondary outcome was the time to first exacerbation. Exploratory analyses examined the effect of daily ICS treatment on exacerbation outcomes. Results-Four latent classes of recurrent wheezing were identified; these were not distinguished by current symptoms or historical exacerbations but differed with regard to allergen sensitization and/or exposures. Annualized exacerbation rates (mean ± SEM/year) were 0.65 ± 0.06 for class 1 ("minimal sensitization"), 0.93 ± 0.10 for class 2 ("sensitization with indoor pet exposure"), 0.60 ± 0.07 for class 3 ("sensitization with tobacco smoke exposure"), and 0.81 ± 0.10 for class 4 ("multiple sensitization and eczema") (p < 0.001). In a research setting of high adherence, daily ICS treatment improved exacerbation rates in classes 2 and 4 but not the other groups. Conclusion-Sensitization and exposure assessments are useful in the prediction of future exacerbation and may identify children most likely to respond favorably to daily ICS treatment.

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Asthmatic/wheezing phenotypes in preschool children: Influential factors, health care and urban-rural differences

Cited by 16 publications

References 27 publications

Risk factors and prognosis of recurrent wheezing in Chinese young children: a prospective cohort study

Risk factors and prognosis of recurrent wheezing in Chinese young children: a prospective cohort study

Geographies of asthma medication purchase for pre-schoolers in Belgium

Phenotypes of Recurrent Wheezing in Preschool Children: Identification by Latent Class Analysis and Utility in Prediction of Future Exacerbation

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