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Natural history of asthma in childhood--a birth cohort study
R Sporik1, S T Holgate, J J Cogswell
1Department of Paediatrics, Poole General Hospital.
Insights
Childhood asthma is complex. Early wheezing without atopy often resolves, while later wheezing is linked to persistent symptoms and atopy, suggesting distinct asthma pathways.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Clinical Epidemiology
Background:
- Atopic disorders, including eczema, wheeze, and hay fever, affect a significant proportion of children.
- Understanding the developmental trajectory and risk factors for persistent childhood respiratory symptoms is crucial.
Purpose of the Study:
- To prospectively investigate the long-term development of atopy and respiratory symptoms in a cohort of high-risk infants.
- To examine the relationship between early wheezing, atopy, and bronchial hyperreactivity (BHR) at 11 years of age.
Main Methods:
- A prospective cohort study followed 67 infants at risk for atopic disorders for 11 years.
- Annual clinical assessments and skin prick testing for the first five years.
- At 11 years, symptom questionnaires and histamine bronchial reactivity (BHR) testing were conducted.
Main Results:
- At 11 years, 35 children were classified as atopic and 32 as non-atopic, with atopy increasing with age.
- Lifetime prevalence of eczema, wheeze, and hay fever were 46%, 63%, and 56%, respectively.
- Wheezing before age 2 was generally transient and not associated with BHR at 11 years; wheezing after age 2 was persistent and linked to atopy and BHR.
Conclusions:
- Childhood asthma appears heterogeneous, with distinct phenotypes based on the timing of wheezing onset.
- Atopy is strongly associated with the persistence of wheeze into later childhood and the presence of bronchial hyperreactivity.
- These findings highlight the importance of differentiating asthma phenotypes for appropriate management and prognosis.
Abstract:
A cohort of 67 babies at risk of developing atopic disorders was followed up prospectively for 11 years. Clinical assessment and skin prick allergen sensitivity testing were performed annually over the first five years. At 11 years the cohort was restudied, symptoms were assessed by questionnaire, and bronchial reactivity (BHR) to histamine was measured. On the basis of skin testing, 35 children were atopic and 32 remained non-atopic. The expression of atopy increased with age. The lifetime prevalence of eczema, wheeze, and hay fever were 46%, 63%, and 56% respectively. The yearly period prevalence of hay fever increased with age, that of eczema declined, while that for wheeze showed a bimodal distribution with a peak before the age of 2 years and a gradual increase thereafter. Of the 21 children who wheezed before their second birthday, most never wheezed again and did not show BHR at 11 years. Of the 21 children whose first wheezing was after 2 years of age, 17 were still wheezing at 11 years and 12 showed BHR. Of the children who wheezed before 2 years of age, 10 were or became atopic, compared with 20 of the 23 children who wheezed at 11 years. These findings suggest that childhood asthma is a heterogeneous condition with atopy being strongly associated with the persistence of wheeze.