Outcome of Asthma and Wheezing in the First 6 Years of Life

Abstract

Rationale: The effect of early life wheezing on respiratory function and continued symptoms through adolescence has not been fully described. Using data from a population-based birth cohort in Tucson, Arizona, we previously described four phenotypes based on the occurrence of wheezing lower respiratory illnesses before age 3 yr and active wheeze at age 6 yr: never wheezers (n ϭ 425), transient early wheezers (n ϭ 164), persistent wheezers (n ϭ 113), and lateonset wheezers (n ϭ 124). Objective: We sought to determine the prognosis for these phenotypes, with reference to lung function and symptoms, through adolescence. Methods: Current wheeze was assessed by questionnaire, lung function was measured by conventional spirometry, and atopy was determined by skin prick tests. Results: The prevalence of atopy and wheeze by age 16 yr was similar for never and transient wheezers and for persistent and late-onset wheezers. Both transient early, and persistent wheezers had significantly lower FEF 25-75 (-259 ml/s, p Ͻ 0.001, and -260 ml/s, p ϭ 0.001, respectively), FEV 1 (-75 ml, p ϭ 0.02, and -87 ml, p ϭ 0.03, respectively), and FEV 1 :FVC ratio (-1.9%, p ϭ 0.002, and -2.5%, p ϭ 0.001, respectively) through age 16 yr compared with never wheezers. Late-onset wheezers had levels of lung function similar to those of never wheezers through age 16 yr. There was no significant change in lung function among subjects with any of the four phenotypes, relative to their peers, from age 6 to 16 yr. Conclusion: Patterns of wheezing prevalence and levels of lung function are established by age 6 yr and do not appear to change significantly by age 16 yr in children who start having asthmalike symptoms during the preschool years.

Ventilation Heterogeneity and Airway Hyperreactivity in Children with Well Controlled Asthma

“…Although our study was cross-sectional, rather than longitudinal, our findings suggest that even among well-controlled asthmatic children, ventilation heterogeneity may increase with increasing age. Similar findings were observed with spirometric values for which longitudinal cohort studies suggest worsening airway obstruction with increasing age [24][25][26]. Our findings suggest that LCI may be more sensitive than spirometry for detecting worsening airway function in well-controlled asthmatic children.…”

Febrile respiratory illnesses in infancy and atopy are risk factors for persistent asthma and wheeze

“…Similarly, HRV-or RSVassociated wheeze in the first 3 yrs of life was associated with asthma at 6 yrs [12]. Patterns of wheezy illnesses appear to be set by 6 yrs and do not appear to change at age 16 yrs in children presenting with asthma-like symptoms early in life [14].…”

Transient early wheeze and lung function in early childhood associated with chronic obstructive pulmonary disease genes

“…10 Furthermore, these airway developmental abnormalities related to TEW have been shown to associate with lower lung function when symptoms have disappeared, which then persists through the rest of childhood and adolescence. [11][12][13][14] Hence TEW might relate to later development of COPD. Our hypothesis is that COPD genes influence structural and functional airway development in utero and hence the occurrence of TEW and that the presence of TEW might be a forerunner of a lifelong lower-thanaverage lung function in a subset of children, eventually predisposing them to COPD.…”