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Characteristics and prognosis of hospital-treated obstructive bronchitis in children aged less than two years
G Wennergren1, S Hansson, I Engström
1Department of Paediatrics I, Gothenburg University, Sweden.
Insights
Most childhood asthma cases resolve by age 6, especially when symptoms are mild. Early wheezing and atopic conditions are linked to persistent asthma, but RSV infection and high IgE are not predictors.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Epidemiology
Background:
- Wheezing in early childhood is common, often triggered by viral infections.
- Asthma in young children presents diagnostic and prognostic challenges.
- Understanding long-term outcomes of early childhood wheezing is crucial for management.
Purpose of the Study:
- To investigate the long-term prognosis of asthmatic symptoms in children under 2 years old.
- To identify factors associated with persistent asthma in early childhood.
- To evaluate the impact of viral infections and atopic history on asthma persistence.
Main Methods:
- Prospective study of 101 children initially admitted for asthmatic symptoms before age 2.
- Follow-up assessment 3-4.5 years later to determine asthma status.
- Analysis of clinical data, viral agents, pulmonary X-rays, and total IgE levels.
Main Results:
- 53% of children were symptom-free by age 3.3-6.3 years; 33% had mild asthma, 8% moderate, and 6% severe.
- Factors correlating with persistent asthma included young age at first episode/admission and other atopic symptoms.
- Respiratory Syncytial (RS) virus, high IgE, heredity, smoking, or pets did not significantly correlate with persistent asthma.
Conclusions:
- Wheezing in early childhood generally has a good prognosis, even after hospitalization.
- Early age at onset and atopic predisposition are key indicators for persistent childhood asthma.
- Many childhood asthma cases are transient, highlighting the need for individualized prognosis assessment.
Abstract:
In a prospective study 101 children aged less than 2 years (median age 10 months), were examined the first time they were admitted to a paediatric ward for asthmatic symptoms. Two-thirds were boys and 58 had parents or siblings with allergic symptoms. During winter-spring, respiratory syncytial (RS) virus was verified in 50% of children. Other viral agents were adenovirus, parainfluenza 3, coxsackie B 2, ECHO 6 and rotavirus. At the acute stage, 54% of the children displayed changes on pulmonary X-ray. The total IgE value was greater than or equal to +2 SD score units in 14 children. At reinvestigation after 3-4.5 years, when the children were aged 3.3-6.3 years, 53% were free from asthmatic symptoms; the median age for the last episode was 2 years. A total of 33% had mild asthma, 8% moderate and 6% severe asthma. The factors which correlated significantly with persistent asthma were: (1) The need for daily medication for at least 6 months. (2) A young age in conjunction with the first wheezing episode and on the first admission to a paediatric ward because of asthmatic symptoms. (3) Other past or present atopic symptoms. Heredity, tobacco smoking at home, having a furry pet, RS virus infection, or high total IgE at the time of the first admission did not correlate significantly with the persistence of asthma 3-4.5 years later. The results emphasize the good overall prognosis of wheezing in early childhood, even when the wheezing is severe enough to lead to inpatient treatment.