One-year follow-up of young children hospitalized for wheezing: the influence of early anti-inflammatory therapy and risk factors for subsequent wheezing and asthma

Abstract

We investigated the 1‐year outcome of children hospitalized for wheezing, paying special attention to the effect of early anti‐inflammatory therapy. In addition, we identified risk factors for recurrent wheezing and asthma. Eighty‐eight children under 2 years old treated in the hospital for wheezing were followed for 1 year. Nebulized anti‐inflammatory therapy was given for 16 weeks: 31 patients received budesonide, 29 patients cromolyn sodium, and 28 control patients received no therapy. The number of subsequent physician‐diagnosed wheezing episodes was recorded. Four months of anti‐inflammatory therapy did not significantly decrease the occurrence of asthma 1 year later; 45% of patients in the cromolyn group, 42% in the budesonide group, and 61% in the control group had asthma, defined as at least two bronchial obstruction episodes during the 1‐year period after the original hospitalization for wheezing. An age over 12 months at the time of the initial bronchial obstructing episode [P = 0.009, risk ratio (RR) = 5.4, 95% confidence interval (CI) = 1.53–19.31], failure to identify a viral cause (P = 0.0003, RR = 12.0, CI = 3.16–45.40), history of wheezing (P = 0.02, RR = 14.6, CI = 1.59–132.10), the presence of atopy (P = 0.01, RR = 5.3, CI = 1.47–19.21), a family history of atopy (P = 0.03, RR = 3.6, CI = 1.15–11.12), and serum eosinophil cationic protein (ECP) ≥ 16 μg/L (P = 0.005) were significant risk factors for asthma. We conclude that early anti‐inflammatory therapy for 4 months does not significantly decrease the occurrence of asthma during the period of 1 year following hospitalization for the original episode of wheezing. Young children requiring hospital admission for wheezing during a respiratory tract infection are at increased risk of having subsequent asthma if they have wheezed previously, if they have atopy or a family history of atopy, if they have elevated serum ECP, if they are over 12 months of age at the original bronchial obstructive episode, and especially when viral studies are negative. Pediatr Pulmonol. 1998; 26:113–119. © 1998 Wiley‐Liss, Inc.

Use of inhaled corticosteroids decreases hospital admissions for asthma in young children

“…[19] In addition, recent controlled clinical trials have failed to show any subsequent long-term benefi ts of ICS after the discontinuation of the treatment in less than 24-month-old children. [20][21][22] Despite long-term benefi ts were lacking, ICSs diminished wheezing symptoms as long as they were consumed, [20,21] which is in line with the present results at the population level. Regional treatment policies seem to exert infl uence on the hospitalization rates, indicating the role of ICSs in the prevention of asthma exacerbations in young children (Table 3).…”

Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases

“…Finnish studies have found that 4 months of treatment with nebulized budesonide reduced the recurrence of wheezing initially [89]. However, the beneficial effect disappeared shortly after termination of the treatment (the children had a mean age of 10.6 months at inclusion and RSV had been detected in 26%) [104]. In addition, the antiinflammatory therapy had no influence on the occurrence of asthma 3 yrs later [105].…”

Asthma and lung function in adulthood after a viral wheezing episode in early childhood

“…14 This cohort has been evaluated in several followup visits from early childhood to adolescence. 14 This cohort has been evaluated in several followup visits from early childhood to adolescence.…”