Wheezing in childhood: incidence, longitudinal patterns and factors predicting persistence

Area of Science:

• Pediatric Allergy and Immunology
• Respiratory Medicine
• Epidemiology

Background:

• Childhood asthma is often viewed simplistically, potentially overlooking diverse clinical trajectories.
• Understanding the natural history of wheeze and its predictors is crucial for effective management.

Purpose of the Study:

• To investigate the incidence and course of wheezing in children over the first 13 years of life.
• To identify risk factors associated with wheezing persistence up to 11-13 years of age.

Main Methods:

• Analysis of a German birth cohort (Multicentre Allergy Study) with 1,314 children recruited in 1990.
• Longitudinal data collection including physical examinations, atopic disease interviews, immunoglobulin E (IgE) measurements, and lung function tests up to age 13.
• Focus on 441 children with complete wheeze course data.

Main Results:

• Wheezing incidence declined with age, with distinct groups identified: early wheezers (<3 yrs), late wheezers (3-6 yrs), and very late wheezers (>6 yrs).
• Wheezing at 13 years was associated with parental atopy, IgE sensitization, elevated total IgE, and early indoor allergen exposure.
• These associations were significantly stronger in children with early-onset wheezing compared to those without early wheeze.

Conclusions:

• The predictive relevance of early atopy for wheezing at age 13 diminishes as the age of wheezing onset increases.
• Early life factors, particularly atopy and allergen exposure, play a significant role in persistent childhood wheeze, especially in early-onset cases.
• This study highlights the heterogeneity in childhood wheeze development and the importance of considering onset timing.