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Characterization of wheezing phenotypes in the first 10 years of life
R J Kurukulaaratchy1, M H Fenn, L M Waterhouse
1The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK. sha@soto.ac.uk
Insights
Persistent childhood wheezing starting early is linked to significant health issues, including asthma and reduced lung function. Late-onset wheezing may also lead to future health problems.
Area of Science:
- Pediatric Respiratory Medicine
- Phenotyping Childhood Illnesses
- Longitudinal Cohort Studies
Background:
- Childhood wheezing illnesses present diverse phenotypes, but their associated disease severity requires further investigation.
- Understanding wheezing phenotypes is crucial for predicting long-term health outcomes in children.
Purpose of the Study:
- To characterize childhood wheezing phenotypes within the first decade of life.
- To assess health outcomes, atopy, lung function, and bronchial hyper-responsiveness in relation to wheezing phenotypes.
Main Methods:
- Prospective study of a whole population birth cohort (n=1456) tracking wheezing natural history.
- Phenotyping wheezing based on symptom onset and persistence up to 10 years of age.
- Assessed adverse health outcomes, spirometry, bronchial hyper-responsiveness, IgE, and skin sensitization at ages 1, 2, 4, and 10 years.
Main Results:
- 37% of early-onset wheezers continued to wheeze at 10 years, showing higher rates of asthma, hospital admissions, and steroid use.
- Persistent wheezers exhibited significantly increased bronchial hyper-responsiveness compared to transient wheezers.
- Both early wheezing groups showed impaired lung function (FEV1, FEV1/FVC ratio, PEF) at age 10 compared to non-wheezers.
- Late-onset wheezers had normal lung function and fewer adverse outcomes than persistent wheezers but similar bronchial hyper-responsiveness.
Conclusions:
- Early-onset persistent wheezing in children is associated with significant morbidity, including atopy, bronchial hyper-responsiveness, and impaired lung function.
- Late-onset wheezing in early childhood may indicate potential for significant future respiratory disease.
Background:
Childhood wheezing illnesses are characterized into different phenotypes. However, severity of the disease associated with these phenotypes has not been extensively studied.
Objectives:
To determine characteristics of childhood wheezing phenotypes in the first decade of life using health outcomes plus measurements of atopy, lung function and bronchial hyper-responsiveness.
Methods:
A whole population birth cohort (n = 1456) was prospectively studied to examine the natural history of childhood wheezing. Children were seen at 1, 2, 4 and 10 years for questionnaire completion and prospectively collected data used to define wheezing phenotypes. Assessment was made of adverse health outcomes plus spirometry, bronchial hyper-responsiveness, serum IgE measurement at 10 years and skin test sensitization at both 4 and 10 years for wheezing phenotypes.
Results:
Phenotypic analysis identified that 37% early life wheezers (symptom onset by age 4 years) still wheezed at 10 years. These persistent wheezers showed significantly more physician-diagnosed asthma in early life (P < 0.005 at 2 years) than early transient wheezers (wheezing transiently with onset by age 4 years). Overall they experienced greater multiple hospital admissions (P = 0.024), specialist referral (P = 0.009) and use of inhaled (P < 0.001) and oral steroids (P < 0.001) than early transient wheezers. They also demonstrated enhanced bronchial hyper-responsiveness compared with early transient wheezers (P < 0.001). However, both groups of early life wheezers showed impairment of baseline lung function at 10 years in comparison with non-wheezers: FEV1 (P < 0.029) and FEV1/FVC ratio (P < 0.001) with persistent wheeze and PEF (P = 0.036) with early transient wheeze. Late-onset wheezers (onset from 5 years onwards) had similar BHR to persistent wheezers but maintained normal lung function at age 10 and had lower cumulative prevalence of adverse health outcomes than persistent wheezers.
Conclusions:
Persistent wheezing with early childhood onset is associated with substantial morbidity in the first decade of life in association with high levels of atopy, bronchial hyper-responsiveness and impaired lung function at 10 years of age. Late-onset wheezing in the first decade of life could harbour potential for similarly significant disease subsequently.
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