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Risk factors for early, persistent, and late-onset wheezing in young children. SIDRIA Collaborative Group
F Rusconi1, C Galassi, G M Corbo
1Department of Pediatrics, University of Milano, Milano, Italy. sail.ped@mailserver.csi.unimi.it
Insights
Childhood wheezing involves various conditions, with different risk factors influencing outcomes. Maternal asthma and smoking are linked to persistent wheezing, while factors like daycare attendance show varied associations with wheezing types.
Area of Science:
- Pediatric Respiratory Medicine
- Epidemiology
- Environmental Health
Background:
- Childhood wheezing is not a monolithic condition, with distinct wheezing-associated respiratory illnesses identified.
- Understanding the diverse risk factors contributing to different wheezing phenotypes is crucial for effective management.
Purpose of the Study:
- To investigate the associations between various familial, prenatal, perinatal, and postnatal risk factors and distinct childhood wheezing conditions.
- To differentiate the etiological pathways contributing to transient early, persistent, and late-onset wheezing.
Main Methods:
- A population-based study involving 16,333 children aged 6-7 years.
- Standardized parental questionnaires collected data on familial history, pregnancy, birth, and early childhood exposures.
- Statistical analysis, including odds ratios and confidence intervals, was used to assess risk factor associations.
Main Results:
- Maternal asthma/COPD and maternal smoking during pregnancy were strongly associated with persistent wheezing.
- Breastfeeding duration showed differential effects: protective for transient early wheezing but a risk factor for late-onset wheezing.
- Having siblings and daycare attendance were risk factors for transient early wheezing but protective against late-onset wheezing.
- Personal history of eczema or allergic rhinitis was significantly associated with persistent and late-onset wheezing.
Conclusions:
- The study highlights that different childhood wheezing conditions are influenced by distinct sets of risk factors.
- Familial and environmental factors play varied roles in the development of transient, persistent, and late-onset wheezing.
- These findings underscore the need for phenotype-specific approaches in understanding and managing childhood respiratory illnesses.
Abstract:
Wheezing in childhood is not a single disorder and different wheezing-associated respiratory illnesses have been recently described. We investigated the association between wheezing conditions and familial, pre-, peri-, and postnatal risk factors. We studied 16,333 children, 6 to 7 yr old, enrolled in a population-based study. Standardized questionnaires were filled in by parents. A total of 1,221 children had transient early wheezing, 671 had persistent wheezing, 918 had late-onset wheezing, and 13,523 never had wheezing or asthma (control group). Maternal asthma or chronic obstructive airway disease were significantly (p < 0.0001) more associated with persistent wheezing than with transient early and late-onset wheezing. The same pattern was observed for exposure to maternal smoke during pregnancy. Having a mother > 35 yr old was protective against transient early wheezing (odds ratio [OR]: 0.68, 95% confidence intervals [95% CI]: 0.53 to 0.86). Breast feeding >/= 6 mo was slightly protective against transient early wheezing (OR: 0.82, 95% CI: 0.68 to 0.97), whereas it was a moderate risk factor for late-onset wheezing (OR: 1.22, 95% CI: 0.99 to 1.50). On the contrary, having siblings and attending a day care center were both risk factors for transient early wheezing (OR: 1.41 [95% CI: 1.21 to 1.64] and 1.70 [95% CI: 1.48 to 1.96], respectively) and protective factors against wheezing of late onset (OR: 0.83 [95% CI: 0.70 to 0.97] and 0.72 [95% CI: 0.59 to 0.88]). There was a stronger (p < 0.0001) positive association between personal history of eczema or allergic rhinitis and persistent and late-onset wheezing than transient early wheezing. Our findings suggest a different contribution of risk factors to wheezing conditions in childhood.