Predicting persistent disease among children who wheeze during early life

Abstract

This study sought to determine factors influencing the persistence of early life wheezing up to the age of 10 yrs and to create a score identifying those with the highest risk of persistent disease.Children were seen at birth, 1, 2, 4 and 10 yrs in a whole population birth cohort study (n=1,456). Information was collected prospectively on wheeze prevalence and subjects were classified into wheezing phenotypes. Early life genetic and environmental risk factors were recorded and skin-prick testing (SPT) was performed at 4 yrs. Independently significant factors for persisting wheeze were identified at logistic regression and used to create a score for persistence.Wheezing persistence from the first 4 yrs to the age of 10 yrs occurred in 37% of early life wheezers. Independent significance for persistence was associated with asthmatic family history, atopic SPT at 4 yrs and recurrent chest infections at 2 yrs, whilst recurrent nasal symptoms at 1 yr conferred reduced risk. A cumulative risk score using these factors identified wheezing persistence in 83% scoring 4 and transience in 80% scoring 0.Thus, a combination of genetic predisposition, early life atopy and recurrent chest infections favours the persistence of early life wheezing. Risk scores using such knowledge could provide prognostic guidance on the outcome of early wheeze. Eur Respir J 2003; 22: 767-771.

Predicting persistence of wheezing: one algorithm does not fit all

“…SCOTT et al [1] have commented, in the light of outcomes of their ''Isle of Wight Birth Cohort study'' (IoWBC) [2,3], on our findings on the risk factors for asthma in the Multicentre Allergy Study (MAS) birth cohort study [4]. We agree that the two studies lead to similar conclusions in regard to early origins of persistent wheezing, heterogeneity of childhood wheezing and the relevance of an atopic background.…”

Patterns of GATA3 and IL13 gene polymorphisms associated with childhood rhinitis and atopy in a birth cohort

“…We have previously reported the development of a predictive index for risk of having persistent asthma up to age 10 years using information available from history and SPT responses. 23 The development of allergic disease, including rhinitis, depends on both genetic and environmental factors and their interactions. It has been suggested that heritable factors predominate over shared environmental influences in asthma, 24 and the same might be true for rhinitis because both diseases are closely linked.…”

Early-life wheeze: "the Child is father of the Man"

“…With a wider timespan, we previously found prevalence for early life (in the first 4 years) wheezing of 40% at 10 years in our cohort [2]. We also showed that 37% of such early-life wheezing was still evident at 10 years as a persistent wheeze phenotype [4] associated with greater airflow limitation, bronchial hyperresponsiveness (BHR), morbidity [2] and risk of asthma death [5]. The remainder of the early-life wheezers were defined as early transient wheeze.…”