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Transient early wheeze is not associated with impaired lung function in 7-yr-old children
1Dept of Paediatric Pneumology and Immunology, Charité, Humboldt University, Berlin, Germany. susanne.lau@charite.de
Insights
Lung function in 7-year-olds varies by wheezing pattern. Determinants of impaired lung function differ between current wheezers and transient early wheezers, indicating unique therapeutic needs for childhood respiratory conditions.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Epidemiology
Background:
- Wheezing phenotypes in early childhood are diverse, including early transient, persistent, and late-onset patterns.
- Understanding the factors influencing lung function across these phenotypes is crucial for targeted interventions.
- The German Multicentre Allergy Study (MAS) provides a valuable prospective cohort for investigating childhood respiratory health.
Purpose of the Study:
- To analyze the determinants of lung function at age 7 in children with distinct wheezing patterns.
- To identify specific risk factors associated with impaired lung function in different wheezing phenotypes.
- To inform the development of tailored therapeutic strategies for childhood wheezing disorders.
Main Methods:
- Prospective cohort study (German Multicentre Allergy Study - MAS) following 1,314 children from birth.
- Annual clinical assessments, structured interviews, and measurement of specific immunoglobulin E (IgE) to allergens.
- Lung function measured by body plethysmography at age 7 in 800 children.
Main Results:
- Current wheezing at age 7 was strongly associated with reduced lung function.
- Determinants for current wheezers included time since first wheeze, parental atopy, indoor allergen sensitization, cord blood IgE, and low birth ponderal index.
- For transient early wheezers, frequent early respiratory infections and maternal smoking during pregnancy were weak determinants of impaired lung function.
Conclusions:
- Determinants of pulmonary function in 7-year-old children are phenotype-specific for wheezing disorders.
- Persistent and late-onset wheezing (asthmatic symptoms) at age 7 are linked to significant expiratory flow impairment.
- Distinct etiological factors necessitate tailored therapeutic approaches for different childhood wheezing phenotypes.
Abstract:
The aim of the present study was to analyse determinants of lung function in 7-yr-old children with different wheezing patterns (early, persistent and late onset) in a prospective cohort study. The German Multicentre Allergy Study (MAS) followed 1,314 children from birth onwards. Annual assessments included clinical check-ups, a structured interview and repeated measurement of specific immunoglobulins Ig(E) directed against food and inhalant allergens. At the age of 7 yrs, lung function was measured by body plethysmography in 800 children. Episodes of wheezing in the past 12 months ("current wheeze") were strongly associated with reduced lung function at age 7 yrs. Children with wheezing episodes only during the first 3 yrs of life showed a slight impairment in maximal expiratory flow when 50% of the forced vital capacity remains to be exhaled (98.9 +/- 24.2 versus 103.2 +/- 22.8% of the predicted value in children who never wheeze). Separate analysis of determinants of pulmonary function within these subgroups resulted in distinctly different patterns. Determinants of impaired lung function in the group of current wheezers were: time in years since first wheeze, a parental history of atopy, current sensitisation to indoor allergens, elevated cord blood IgE levels and a low ponderal index at birth. In the group of transient early wheezers, frequent lower respiratory tract infections early in life and maternal smoking during pregnancy were significant but weak determinants of impaired lung function. The present results indicate that determinants of pulmonary function in 7-yr-old children differ with respect to different wheezing phenotypes, demanding different therapeutic strategies. Although transient early wheezers were found to have normal-to-subnormal lung function, children with asthmatic symptoms (persistent and late-onset disease) at age 7 yrs already show significant impairment of expiratory flow volumes.