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Recurrent wheezing in infants and young children and bronchial hyperresponsiveness: a perspective
1Department of Pediatrics and Medicine, Creighton University School of Medicine, Omaha, NE, USA. rhopp@creighton.edu
Insights
Many young children experience wheezing, but asthma doesn't explain all cases. This study explores bronchial hyperresponsiveness (BHR) in non-asthmatic children with recurrent wheezing, suggesting further research is needed.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Epidemiology
Background:
- Recurrent wheezing affects a significant portion of young children, with asthma accounting for only a fraction of cases.
- Environmental tobacco smoke (ETS) exposure and post-bronchiolitis sequelae are recognized phenotypes of recurrent wheezing in children.
- Bronchial hyperresponsiveness (BHR) is a hallmark of asthma, but its role in non-asthmatic recurrent wheezing remains understudied.
Purpose of the Study:
- To investigate the presence and significance of bronchial hyperresponsiveness (BHR) in young children experiencing recurrent wheezing without a formal asthma diagnosis.
- To compare BHR levels in children with different recurrent wheezing phenotypes, including those exposed to environmental tobacco smoke (ETS) and those with a history of bronchiolitis.
- To propose a hypothesis for studying BHR in non-asthmatic children with recurrent wheezing prospectively.
Main Methods:
- Review of existing epidemiological data and studies on childhood wheezing and asthma.
- Analysis of available research on bronchial hyperresponsiveness (BHR) in pediatric populations, including asthmatic and non-asthmatic children.
- Identification of gaps in current knowledge regarding BHR in specific phenotypes of recurrent wheezing.
Main Results:
- Bronchial hyperresponsiveness (BHR) is observed in young children with asthma, similar to adult patterns.
- Children experiencing recurrent wheezing post-bronchiolitis show some degree of BHR.
- Infants and young children exposed to environmental tobacco smoke (ETS) as a group exhibit increased BHR.
Conclusions:
- A substantial percentage of young children experience recurrent wheezing from causes other than asthma.
- Bronchial hyperresponsiveness (BHR) is present in various forms of non-asthmatic recurrent wheezing, including post-bronchiolitis and ETS exposure.
- Further longitudinal studies are warranted to understand the implications of exaggerated BHR in non-asthmatic children with recurrent wheezing and to test a prospective hypothesis.
Abstract:
Epidemiological studies report a 50% incidence of at least one wheezing episode in young children. If we can argue that 10% of children have asthma sometime during their pediatric years, it still leaves a significant percentage of children with an unexplained cause for their wheezing. Other recognized phenotypes of recurrent wheezing include young children exposed to excessive environmental tobacco smoke (ETS), while other infants wheeze recurrently following a significant episode of bronchiolitis. Bronchial hyperresponsiveness (BHR) is a universally recognized phenomenon of asthma, but its presence in young children with recurrent wheezing is not as well studied. Currently available studies demonstrates that BHR is also seen in young pediatric asthmatics, paralleling what is well recognized in adolescent or adult asthma. In those children with post-bronchiolitis wheezing, BHR appears to be present to a degree; while infants and young children exposed to ETS have increased BHR, as a group. If exaggerated BHR in recurrent wheezing children without asthma has the same inherent disadvantage as it does in asthmatic children, additional studies looking directly at this issue in a longitudinal fashion need to be designed. A hypothesis of BHR in non-asthmatic children is presented that could be studied prospectively.