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Wheezy bronchitis in childhood: a distinct clinical entity with lifelong significance?
Carole A Edwards1, Liesl M Osman, David J Godden
1Respiratory Unit, Aberdeen Royal Infirmary, Aberdeen, Scotland.
Insights
Childhood wheezy bronchitis patients maintained normal lung function into adulthood but now show a faster decline. This accelerated decline may lead to obstructive airways disease later in life.
Area of Science:
- Pulmonology
- Epidemiology
- Pediatric Respiratory Medicine
Background:
- Childhood wheezy bronchitis was historically recognized but later relabeled as asthma.
- Previous studies showed childhood wheezy bronchitis patients had better adult lung function than childhood asthma patients.
- This study re-evaluated a cohort 12 years later to assess the long-term respiratory outcomes.
Purpose of the Study:
- To determine if the improved lung function in adults who had childhood wheezy bronchitis was maintained over time.
- To compare the long-term respiratory health trajectories of individuals with childhood wheezy bronchitis, childhood asthma, and healthy controls.
Main Methods:
- A follow-up study in 2001 of 283 participants (aged 45-50 years) from a 1989 cohort.
- Assessment of respiratory symptoms and smoking status through interviews.
- Measurement of spirometry (FEV1) to evaluate lung function.
Main Results:
- Individuals with childhood asthma had significantly lower FEV1 compared to both wheezy bronchitis and control groups in adulthood.
- Both childhood wheezy bronchitis and asthma groups experienced a greater decline in FEV1 between 1989 and 2001 compared to controls.
- In 2001, the childhood asthma group reported more respiratory symptoms than the wheezy bronchitis group, who in turn reported more symptoms than controls.
Conclusions:
- Adults with a history of childhood wheezy bronchitis, despite initial normal lung function, now exhibit a more rapid decline in lung function.
- This accelerated decline suggests a potential risk for developing obstructive airways disease later in life.
- The findings highlight the importance of long-term respiratory monitoring for individuals with a history of childhood wheezy bronchitis.
Background:
Historically, clinicians have recognized the existence of the clinical syndrome of childhood wheezy bronchitis. In the late 1960s, children with this syndrome were relabeled as having asthma, and the term wheezy bronchitis was abandoned. In a 1989 study of a cohort that originally had been studied in 1964, we reported that those who had childhood wheezy bronchitis had as adults attained lung function similar to that of healthy control subjects and had less significant symptoms than did those who had experienced childhood asthma, in whom lung function was reduced. In this study, we reexamined these subjects 12 years later to determine whether the improved outcome of the wheezy bronchitis group had been maintained.
Methods:
In 2001, we followed up the 283 participants of the 1989 study, who were now aged 45 to 50 years. In interviews, respiratory symptoms and smoking status were assessed. Spirometry was measured.
Results:
One hundred seventy-seven subjects (63%) completed the study. After adjusting for age, height, gender, socioeconomic status, smoking status, and number of pack-years smoked, the current FEV(1) in the childhood asthma group (mean, 2.45 L; 95% confidence interval, 2.29 to 2.62) was significantly lower than the wheezy bronchitis group (2.78 L, 95% confidence interval, 2.64 to 2.91; p < 0.01) and the control group (2.96 L; 95% confidence interval, 2.83 to 3.1; p < 0.01). The difference between the wheezy bronchitis group and the control subjects was not significant (p = 0.06). Between 1989 and 2001, both the childhood wheezy bronchitis group (p < 0.01) and the childhood asthma group (p = 0.01) had greater declines in FEV(1) than did the control group (asthma group decline, - 0.75 L [95% confidence interval, - 0.66 to - 0.84]; wheezy bronchitis group decline, - 0.75 L [95% confidence interval, - 0.68 to - 0.83]; control group decline, - 0.59 L [95% confidence interval, - 0.52 to - 0.67]). In 2001, the asthma group had more symptoms than did the wheezy bronchitis group (p < 0.01), who were more symptomatic than the control group (p < 0.01).
Conclusion:
Those with childhood wheezy bronchitis, having achieved normal lung function in earlier adulthood, now show a more rapid decline in lung function than did control subjects. If this rate of decline persists, these subjects may develop obstructive airways disease in later life.