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Wheezing phenotypes in young children: an historical cohort study
Alfredo Cano-Garcinuño1, Isabel Mora-Gandarillas,
1Villamuriel Primary Care Health Centre, Regional Health Service, Castilla y León, Spain.
Insights
This study identified four infant wheezing phenotypes using doctor-diagnosed episodes and incidence rates, revealing distinct patterns and their association with later asthma. Understanding these wheezing phenotypes improves infant respiratory health insights.
Area of Science:
- Pediatric Pulmonology
- Epidemiology
- Allergy and Immunology
Background:
- Infant wheezing phenotypes are typically based on questionnaires, not prospectively diagnosed episodes or incidence rates.
- Previous descriptions lack incidence data for early childhood wheezing patterns.
Purpose of the Study:
- To identify wheezing phenotypes in the first three years of life.
- To describe incidence trends of these phenotypes.
- To investigate their predictive relationship with asthma at six years of age.
Main Methods:
- Latent class analysis identified wheezing phenotypes in 3,739 children from birth.
- Joinpoint regression models analyzed changes in wheezing incidence rates.
- Doctor-diagnosed wheezing episodes and active asthma at six years were recorded.
Main Results:
- Four phenotypes were identified: never/infrequent wheeze and three distinct wheezing patterns.
- Two early phenotypes began wheezing at six months; one transient, one recurrent.
- A third phenotype showed delayed onset, rising incidence, and links to allergic asthma.
Conclusions:
- Utilizing incidence rates clarifies the natural history of infant wheezing.
- Identified phenotypes show varying associations with asthma at age six.
- The classification demonstrated weak predictive ability for asthma due to low sensitivity.
Background:
Wheezing phenotypes in young children have usually been described on the basis of questionnaire surveys instead of prospectively doctor-diagnosed episodes, and have never been described in terms of incidence rates.
Aims:
To identify wheezing phenotypes in the first three years and describe their incidence trends, and to investigate their relationship with asthma at six years of age.
Methods:
Doctor-diagnosed wheezing episodes in the first 36 months and active asthma at six years were identified in a historical cohort of 3,739 children followed from birth in 29 primary care health centres in Spain. Wheezing phenotypes were identified by means of latent class analysis. Changes in incidence rates of wheezing were identified through joinpoint regression models and their predictive ability for asthma was analysed.
Results:
One never/infrequent wheeze phenotype and three wheezing phenotypes were identified. There were two early phenotypes which started wheezing at a median age of six months, one of which was transient while the other had a heavy recurrence of episodes. A third phenotype exhibited a delayed onset of wheezing, a constant rise in incidence through the first 36 months, and a relationship with allergic asthma. These three phenotypes had a higher prevalence of active asthma at six years than the never/infrequent wheeze phenotype, but the classification had a weak predictive ability for asthma due to low sensitivity.
Conclusions:
The use of incidence rates contributes to the clarification of the natural history of infant wheezing.
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