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The association between early life lung function and wheezing during the first 2 yrs of life
S Young1, J Arnott, P T O'Keeffe
1Dept of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
Insights
Infant wheezing in the first year is often transient, linked to early small airway issues. Wheezing persisting into the second year suggests different airway problems, potentially indicating asthma.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Neonatology
Background:
- Infant wheezing is a common concern, with some infants predisposed due to early lung function abnormalities.
- Understanding the relationship between infant lung function and wheezing patterns is crucial for early diagnosis and intervention.
Purpose of the Study:
- To investigate the association between infant lung function, assessed in the first year of life, and the occurrence of wheeze during the first two years.
- To differentiate between transient and persistent wheezing patterns and their links to lung function and risk factors.
Main Methods:
- A cohort of 253 infants underwent respiratory function assessments at 1, 6, and 12 months of age.
- Parental history (asthma, atopy) and maternal smoking during pregnancy were recorded.
- Wheezing was identified through parental reports and physician diagnoses over the first two years.
Main Results:
- Infants who wheezed (W) showed impaired lung function at 1 month compared to non-wheezing (NW) infants, prior to any illness.
- Wheezing in the first year only (Y1) showed resolved lung function differences by 12 months.
- Persistent wheezing (Y2, Y1&2) was associated with persistent lung function differences and increased parental asthma and maternal smoking.
Conclusions:
- Early-life reduced small airway caliber may contribute to transient wheezing in the first year.
- Wheezing persisting into the second year is linked to distinct airway abnormalities and may represent an early sign of asthma.
- Maternal antenatal smoking is a significant risk factor associated with persistent wheezing.
Abstract:
Reports have suggested that certain infants are predisposed to wheezing in the first 2 yrs of life due to abnormal lung function, prior to the first wheezing illness. The authors investigated the association between infant lung function and wheeze during the first 2 yrs of life. A cohort of 253 infants was evaluated. Respiratory function assessment was performed at 1, 6, and 12 months of age. Parental history of asthma, atopy, and maternal antenatal smoking habits were recorded. An infant was identified as having wheezed on the basis of parental report and, where possible, physician diagnosis. One hundred and sixty infants (63%) had complete diary and questionnaire information on wheeze available for analysis. Of these: 79 infants (50%) had never wheezed (NW) during the first 2 yrs of life and 81 had reported wheeze (W) (50%). Of those with a report of wheeze, the distribution through the first 2 yrs of life was; 28 during the first year of life only (Y1), 21 in the second year of life only (Y2), and 32 wheezed in both the first and second years of life (Y1&2). At the age of 1 month, prior to any lower respiratory illness, the W group had impaired lung function in comparison to the NW group. In Y1 infants, the neonatal lung function differences resolved by 12 months of age. In Y2 and Y1&2 infants lung function differences persisted throughout the first year of life. Prevalence of parental asthma and maternal antenatal smoking was increased in the W group p=0.001, p=0.008, respectively), in comparison to the NW infants. Maternal antenatal smoking prevalence was increased in the Y2 and Y1&2 infants in comparison to the NW group (p=0.04), (p=0.01), respectively. Wheezing during the first year of life is often a transient condition which improves with time. It appears to be related to early life reduced small airway calibre. Wheezing that begins or persists into the second year of life is usually associated with a different abnormality of the airways. Commencement or persistence of wheeze into the second year of life may be part of the clinical entity recognized as asthma.