Prevalence, Severity, and Treatment of Recurrent Wheezing During the First Year of Life: A Cross-Sectional Study of 12,405 Latin American Infants

Abstract

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Purpose: This study aimed to determine the prevalence and severity of recurrent wheezing (RW) defined as ≥3 episodes of wheezing, risk factors, and treatments prescribed during the first year of life in Latin American infants. Methods: In this international, cross-sectional, and communitybased study, parents of 12,405 infants from 11 centers in 6 South American countries (Argentina, Brazil, Chile, Colombia, Peru, and Uruguay) completed a questionnaire about wheezing and associated risk/protective factors, asthma medications, and the frequency of and indications for the prescription of antibiotics and paracetamol during the first year of life. Results: The prevalence of RW was 16.6% (95% CI 16.0-17.3); of the 12,405 infants, 72.7% (95% CI 70.7-74.6) visited the Emergency Department for wheezing, and 29.7% (27.7-31.7) was admitted. Regarding treatment, 49.1% of RW infants received inhaled corticosteroids, 55.7% oral corticosteroids, 26.3% antileukotrienes, 22.9% antibiotics ≥4 times mainly for common colds, wheezing, and pharyngitis, and 57.5% paracetamol ≥4 times. Tobacco smoking during pregnancy, household income per month <1,000 USD, history of parental asthma, male gender, and nursery school attendance were significant risk factors for higher prevalence and severity of RW, whereas breast-feeding for at least 3 months was a significant protective factor. Pneumonia and admissions for pneumonia were significantly higher in infants with RW as compared to the whole sample (3.5-fold and 3.7-fold, respectively). Conclusions: RW affects 1.6 out of 10 infants during the first year of life, with a high prevalence of severe episodes, frequent visits to the Emergency Department, and frequent admissions for wheezing. Besides the elevated prescription of asthma medications, there is an excessive use of antibiotics and paracetamol in infants with RW and also in the whole sample, which is mainly related to common colds.

Healthcare utilization in infants and toddlers with asthma‐like symptoms

“…The access to such a large medical database provides us with a rich source of information and reveals that the frequency of asthma‐like symptoms in infants and toddlers is high. Over a third of all infants fulfilled GINA criteria for asthma‐like symptoms, similar to the Tucson and Bisgaard studies, but double that in two recent real‐world epidemiological studies . However, only a small minority received controller therapy, even using permissive criteria of 50% of the recommended dose to define controller user.…”

“…Low SES was associated with a higher prevalence of wheezing in infants but controller therapy was less prevalent within the Orthodox Jewish and Arab populations who tend to have a lower SES as well as larger families and more crowded living conditions . The Latino studies of wheezing infants found that a low household income per month was associated with a higher prevalence of recurrent wheezing and severity markers whereas others showed only a slight effect of SES on wheezing in young children and no effect in adolescents in Canada …”

Prevalence and associated factors of wheeze in early infancy

“…We showed that the prevalence of wheeze in early infancy (age < 4 months) is 7.7%, which is almost the same proportion (7.9%) of infants with recurrent wheezing who developed wheezes before the age of 3 months in reports from South America 14 . Although several studies have shown the prevalence of wheeze in infants (age < 12 months) as 37–56%, 1–3 about 20% of the infants developed wheeze within 4 months of age.…”

“…Although some studies have shown the prevalence and associated factors of wheeze in infants up to 1 year of age in some countries 1–3 or internationally, 4,14 no study has yet described the prevalence and associated factors of wheeze in early infancy (defined as age < 4 months), which is a risk factor for recurrent wheezing 13 ). Therefore, this population‐based, cross‐sectional study aimed to describe the prevalence of wheeze during early infancy and to ascertain factors associated with wheeze as part of a long‐term plan to identify potentially feasible interventions for prevention of wheeze.…”

Prevalência, gravidade e fatores de risco associados à sibilância recorrente em lactentes nascidos em Ribeirão Preto em 2010

“…Estudo recente demonstrou prevalência de DA semelhante em lactentes sibilantes recorrentes (16,8%) e em não sibilantes (16,6%) e não encontrou associação entre o diagnóstico de dermatite atópica e sibilância recorrente no primeiro ano de vida. 22 No presente estudo, a prevalência de DA foi de 10,1% nos sibilantes recorrente e de 7,5% nos não sibilantes. A prevalência de dermatite atópica na família foi 11,5% e esta foi identificada como fator de risco independente para sibilância recorrente grave.…”