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Predictors of asthma three years after hospital admission for wheezing in infancy
T M Reijonen1, A Kotaniemi-Syrjänen, K Korhonen
1Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland. tiina.reijonen@iobox.fi
Insights
Early anti-inflammatory therapy did not prevent asthma in infants hospitalized for wheezing. However, early allergic sensitization, particularly to pets, and atopic dermatitis are key predictors of childhood asthma development.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Epidemiology
Background:
- Wheezing in infancy is a common condition with variable long-term outcomes, including the development of asthma.
- Identifying early risk factors for persistent asthma is crucial for timely intervention.
Purpose of the Study:
- To assess the impact of early anti-inflammatory therapy on asthma development 3 years post-infant wheezing hospitalization.
- To investigate the roles of allergic sensitization and respiratory syncytial virus (RSV) infection in asthma pathogenesis.
Main Methods:
- A randomized controlled trial involving 89 infants hospitalized for wheezing, followed for 3 years.
- Interventions included 16 weeks of cromolyn sodium or budesonide; a control group received no therapy.
- Asthma diagnosis was based on physician-diagnosed wheezing episodes and clinical criteria.
Main Results:
- No significant difference in asthma occurrence was observed between the anti-inflammatory therapy groups and the control group (48-55%).
- Predictors of asthma included age >12 months, prior wheezing history, atopic dermatitis, and positive skin prick tests.
- Sensitization to pets predicted asthma, while RSV infection and early pet contact were associated with decreased asthma occurrence.
Conclusions:
- Four months of early anti-inflammatory therapy does not influence the development of asthma after infantile wheezing.
- Early sensitization to indoor allergens (especially pets) and atopic dermatitis are significant predictors of subsequent asthma.
- RSV infection in wheezing infants may be associated with a more favorable long-term outcome compared to other infections.
Objective:
To evaluate the influence of early antiinflammatory therapy in the development of asthma 3 years after hospitalization for wheezing in infancy. In addition, the effects of allergic sensitization and respiratory syncytial virus (RSV) infection on the development of asthma were investigated.
Design And Setting:
A randomized, controlled follow-up study in a university hospital that provides primary hospital care for all pediatric patients in a defined area.
Patients:
Eighty-nine infants under 2 years of age who had been hospitalized for infection associated with wheezing and followed up for 3 years.
Intervention:
Early antiinflammatory therapy was given for 16 weeks; 29 patients received cromolyn sodium and 31 received budesonide. Twenty-nine control patients received no therapy.
Outcome Measures:
Clinical diagnosis of current asthma, defined as having at least 3 episodes of physician-diagnosed wheezing and either a wheezing episode during the preceding year or ongoing antiinflammatory medication for asthma.
Results:
Fourteen (48%) patients in the former cromolyn group, 15 (48%) in the former budesonide group, and 16 (55%) in the control group had current asthma. The significant predictors of asthma were age over 12 months (risk ratio [RR] 4.1; 95% confidence interval [CI] = 1.59-10.35), history of wheezing (RR 6.8; CI = 1.35-34.43), and atopic dermatitis on study entry (RR 3.4; CI = 1.17-9.39). Skin prick test positivity at the age of 16 months significantly predicted asthma (RR 9.5; CI = 2.45-36.72). In addition, all of the 18 (20%) children sensitized with furred pet developed asthma. RSV identification (RR 0.3; CI = 0.08-0.80) and early furred pet contact at home (RR 0.3; CI 0.10-0.79) were associated with the decreased occurrence of asthma.
Conclusions:
Antiinflammatory therapy for 4 months has no influence on the occurrence of asthma 3 years after wheezing in infancy. Early sensitization to indoor allergens, especially to pets, and atopic dermatitis predict subsequent development of asthma. RSV infection in wheezing infants may have a better outcome than other infections.