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Wheezing in early life and asthma at school age: predictors of symptom persistence
P Csonka1, M Kaila, P Laippala
1University of Tampere, Medical School, Finland. peter.csonka@uta.fi
Insights
Identifying early childhood wheezing predictors is crucial. Factors like family asthma history, allergies, and smoke exposure in early years predict persistent symptoms into school age.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Epidemiology
Background:
- Early childhood wheezing is a common condition, often linked to later asthma development.
- Predicting wheezing persistence in young children is challenging due to high spontaneous recovery rates.
- Lack of clear predictors complicates evidence-based guidelines for managing wheezy infants and toddlers.
Purpose of the Study:
- To identify variables predicting persistent wheezing symptoms from early childhood into school age.
- To define risk factors for identifying children under 3 years old with ongoing wheezing at school age.
Main Methods:
- A cross-sectional survey utilizing questionnaires distributed to 2,027 randomly selected school children aged 6-13 years.
- Analysis of 1,829 returned questionnaires (90% response rate) to assess early childhood wheezing history and current symptoms.
- Logistic regression analysis to determine independent predictors of symptom persistence.
Main Results:
- 10.2% of children sought emergency care for wheezing in the first 3 years; only 17.2% required similar treatment in the preceding year.
- 11.4% of school-aged children had current asthma.
- Family history of asthma, itchy rash, food allergy, and early-life tobacco smoke exposure were independently associated with persistent wheezing.
Conclusions:
- Children with early wheezing and risk factors like allergies, family asthma history, or smoke exposure are at higher risk for persistent symptoms.
- Identifying these risk factors can aid in early intervention and management strategies for wheezy children.
- Further research can refine guidelines for long-term care of infants and toddlers with wheezing.
Abstract:
Early childhood wheezing is associated with asthma later in life. However, the high spontaneous recovery rate and the lack of firm predictors for persistence of wheezing complicates the development of evidence-based guidelines for long-term management of wheezy infants and toddlers. Our aim was to define variables that could be used to identify wheezy individuals younger than 3 years of age who would continue to be symptomatic at school age. The method used was a questionnaire-based cross-sectional survey of 2,027 randomly chosen, 6-13-year-old school children. Altogether 1,829 (90%) questionnaires were returned. Emergency medical care had been sought for 186 (10.2%) children for wheezing during the first 3 years of life, and only 17.2% of these children had received similar emergency treatment during the 12 months preceding the survey. The total proportion of children with current asthma at school age was 11.4%. A logistic regression analysis indicated that for the early wheezers, a family history of asthma, an itchy rash or food allergy, and exposure to tobacco smoke at home before the age of 3 years, were all independently associated with symptom persistence until school age. Among all wheezy children younger than 3 years, those who have a history of food allergy, itchy rash, asthma occurrence in a sibling or parent, or are exposed to tobacco smoke during the first years of life are at highest risk for symptom persistence until school age.