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[Asthma in infants: current concepts]
1Service de pneumologie et d'allergologie pédiatriques, hôpital Necker-Enfants-Malades, Paris, France.
Insights
Many childhood asthma cases persist into later years. Atopic predisposition is the best predictor for persistent asthma, highlighting the need for environmental protection measures in at-risk children.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Epidemiology
Background:
- Early childhood asthma is clinically defined by recurrent wheezing episodes before age two.
- Approximately 40% of children with early asthma symptoms continue to experience them in later childhood.
- Distinguishing transient wheeze from chronic asthma in young children is challenging.
Purpose of the Study:
- To explore the significance of early childhood asthma and identify predictive markers for persistent disease.
- To evaluate the role of atopic predisposition in the long-term prognosis of childhood asthma.
- To underscore the importance of preventive strategies for at-risk infants and children.
Main Methods:
- Review of birth cohort studies (e.g., Tucson, Wight Island) examining asthma persistence.
- Analysis of clinical definitions and diagnostic criteria for early childhood asthma.
- Evaluation of predictive criteria for persistent asthma, focusing on atopic predisposition.
Main Results:
- No specific biological marker reliably differentiates transient from persistent childhood asthma.
- Atopic predisposition is identified as the strongest predictive criterion for asthma persistence.
- Early childhood asthma has a significant likelihood of persisting into later childhood.
Conclusions:
- Environmental protection, including avoidance of passive smoking and allergens, is crucial for at-risk children.
- Early identification of atopic predisposition aids in predicting persistent asthma.
- Further research is needed to identify definitive markers for asthma chronicity.
Abstract:
Early childhood bronchial asthma is defined on a clinical basis as the occurrence of at least three episodes of wheeze before 2 years of age, once excluded a chronic obstructive lung disease, mainly cystic fibrosis. Recent birth cohort studies (Tucson, Wight island) showed that approximately 40% of early childhood asthma remain symptomatic in later childhood. Thus in any young child with asthma the question is raised of its significance, ie transient bronchial hyper-reactivity or first manifestations of a chronic asthma. At the present time, there is no specific marker which may clearly differentiate between these two opposite evolutions, and the evidence for an atopic predisposition remains the best predictive criteria for persistent asthma. This justifies preventive measures directed towards environmental protection of the at risk young child: mainly passive smoking and allergen avoidance.