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Recognizing early asthma
1College of Medicine, University of Arizona, Tucson, USA.
Insights
Identifying infants at risk for developing asthma is crucial. This study presents an algorithm to help distinguish persistent asthma from transient wheezing in early childhood.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Epidemiology
Background:
- Asthma often manifests in early childhood, with significant wheezing persistence.
- Distinguishing transient early wheezing from developing asthma is challenging due to variable symptoms and lack of definitive markers.
- Existing genetic and serological markers (e.g., immunoglobulin E, eosinophils) lack sufficient sensitivity and specificity for individual risk prediction.
Purpose of the Study:
- To identify children at high risk of developing asthma.
- To differentiate between transient early wheezing and persistent asthma development.
- To propose an algorithm for assessing asthma risk in infants.
Main Methods:
- Longitudinal study analysis of children with early wheezing lower respiratory illnesses (LRIs).
- Evaluation of existing genetic and epidemiological risk factors.
- Assessment of serum immunoglobulin E (IgE) and peripheral eosinophil counts.
- Development of a predictive algorithm based on identified criteria.
Main Results:
- At least 40% of children with early wheezing LRIs continue to experience wheezing at age six.
- Current predictive markers are insufficient for accurate individual risk assessment.
- An algorithm is proposed to aid in determining asthma risk in infants.
Conclusions:
- Early identification of children at risk for persistent asthma is essential.
- A novel algorithm offers a potential tool for assessing asthma risk in infants.
- Further validation of the algorithm is needed for clinical application.
Abstract:
Asthma symptoms often develop during the first years of life. Longitudinal studies show that at least 40% of children with wheezing lower respiratory illnesses (LRIs) during the first 3 years of life still have wheezing episodes at 6 years of age. Thus, it is important to identify children at risk of developing asthma, and to distinguish these from those in whom early wheezing is likely to be transient. This is complicated, however, by the variable nature of asthma and the lack of specific and sensitive markers. Genetic markers and epidemiologic risk factors for asthma have been identified, but cannot be used to predict the development of asthma in an individual patient. Similarly, infants who subsequently develop asthma in childhood have higher serum immunoglobulin E (IgE) and peripheral eosinophil counts than those who do not develop asthma, but, again, these factors are not sufficiently sensitive and specific to allow identification of children at risk of developing asthma. An algorithm is presented that outlines possible criteria to determine the risk of developing asthma in infants.