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Risk factor associations with wheezing patterns in children followed longitudinally from birth to 3(1/2) years
A Sherriff1, T J Peters, J Henderson
1Unit of Paediatric and Perinatal Epidemiology, Institute of Child Health, University of Bristol, Bristol, UK. Andrea.Sherriff@bris.ac.uk
Insights
Most infants who wheeze early do not continue to wheeze past age three. Key risk factors for early wheeze include environmental exposures and parental asthma history, with atopy predicting later wheeze development.
Area of Science:
- Pediatric Respiratory Medicine
- Epidemiology
- Genetics
Background:
- Limited longitudinal data exists on early childhood wheeze patterns.
- Not all infants with wheeze progress to childhood asthma.
- Understanding wheeze phenotypes is crucial for early intervention.
Purpose of the Study:
- To identify risk factors for distinct wheeze patterns in preschool children.
- To differentiate between early, persistent, and late-onset wheeze.
- To inform early identification and management strategies for childhood respiratory issues.
Main Methods:
- Prospective cohort study using the Avon Longitudinal Study of Parents and Children (ALSPAC).
- Maternal reports collected on child wheeze at 0-6 months and 30-42 months.
- Multivariable logistic regression analyzed risk factors for wheezing phenotypes.
Main Results:
- Over 70% of early wheezers (0-6 months) ceased wheezing by 3.5 years.
- Early wheeze associated with older siblings, male sex, bottle feeding, prenatal smoke, atopy, and parental asthma.
- Persistent wheeze linked to preterm birth, young maternal age, housing, atopy, and maternal asthma history.
- Late-onset wheeze primarily predicted by atopy and family asthma history.
Conclusions:
- Distinct wheezing syndromes emerge by preschool age, with some overlap.
- Further follow-up will determine the long-term significance of early risk factors for asthma development.
Background:
There is a paucity of detailed longitudinal data on wheeze in early childhood. Not all children who wheeze in early infancy will continue to wheeze into childhood and beyond. This study aims to investigate possible risk factors for different patterns of wheeze in the pre-school years.
Subjects And Methods:
Study participants were part of the Avon Longitudinal Study of Parents and Children (ALSPAC). Maternal reports of child wheeze between birth and 6 months and again between 30 and 42 months were gathered prospectively. Children were categorized into early wheeze, persistent wheeze or late onset wheeze. A large number of risk factors were assessed for each wheezing phenotype using multivariable logistic regression models.
Results:
Over 70% of children who wheezed in the first 6 months did not wheeze 3 years later. Wheezing between 0-6 months was independently associated with the presence of older siblings, male sex, delivery between April and December, bottle feeding, young maternal age, prenatal tobacco smoke exposure, atopy and parental history of asthma. From within this group of early wheezers, risk factors for wheeze that persisted beyond 6 months included pre-term delivery, young maternal age, living in rented local authority housing, atopy and a maternal (not paternal) history of asthma. Atopy and a family history of asthma emerged as the main predictors of wheeze that developed after 6 months of age.
Conclusion:
It is clear that a number of wheezing syndromes exist by 3(1/2) years, albeit with some degree of overlap. Detailed follow-up of this cohort is underway to determine whether risk factor associations determined in the first 3(1/2) years have long-term significance for the clinical entity termed 'asthma'.