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Infant wheeze, comorbidities and school age asthma
Asa Neuman1, Anna Bergström, Per Gustafsson
1Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden.
Insights
Infant wheeze increases the risk of developing childhood asthma. Key risk factors for asthma at age 8 include allergic heredity, severe wheezing, infant eczema, and abdominal pain.
Area of Science:
- Pediatric Pulmonology
- Epidemiology
- Allergy and Immunology
Background:
- Early childhood wheeze is common, but predicting which infants will develop asthma by school age remains challenging.
- Understanding long-term outcomes for infant wheezers is crucial for early intervention and management.
Purpose of the Study:
- To identify clinical risk factors predicting the development of asthma at age 8 in children who experienced wheezing during infancy.
- To analyze a population-based birth cohort to determine predictors of persistent asthma.
Main Methods:
- Prospective follow-up of 3,251 children from infancy to age 8.
- Multivariate logistic regression analysis was employed to identify significant risk factors.
Main Results:
- Infant wheezers had a nearly fourfold increased risk of asthma at age 8 (aOR 3.68).
- Independent risk factors for school-age asthma in wheezing infants included allergic heredity (aOR 1.53), increased wheeze frequency (aOR 3.41), infant eczema (aOR 2.31), and recurrent abdominal pain (aOR 2.33).
- Children with three or four identified risk factors showed a 38% prevalence of asthma at age 8.
Conclusions:
- Allergic heredity, wheeze severity, infant eczema, and recurrent abdominal pain are significant predictors of asthma at age 8 among children with a history of infant wheeze.
- These findings highlight specific clinical markers for identifying high-risk infants who may develop persistent asthma.
Background:
Factors associated with early onset of wheeze have been described, but there is limited knowledge on which of these infant wheezers who will have developed asthma in school age. The aim was to identify clinical risk factors for asthma in the 8-yr-old children that wheezed during infancy in a population-based setting.
Methods:
Three thousand two hundred and fifty-one children from a population-based birth cohort followed prospectively from infancy until age 8 yr were included in the study. Data were analyzed using multivariate logistic regression analysis.
Results:
Parents reported any wheeze episode before age 2 yr in 823 subjects (25%). Infant wheezers had an almost fourfold risk of asthma at age 8 [adjusted odds ratio (aOR) 3.68, 95% CI 2.74-4.96], equivalent to an asthma prevalence of 14% compared with 4% among non-wheezers (p < 0.001). After adjustments for sex, exposure to tobacco smoke and indoor dampness/mould, allergic heredity (aOR 1.53, 95% CI 1.02-2.30), increased frequency of wheeze (aOR 3.41, 95% CI 2.09-5.56 for children with ≥3 episodes compared with ≤2 episodes during the first 2 yr of life), infant eczema (aOR 2.31, 95% CI 1.52-3.49), and recurrent abdominal pain (aOR 2.33, 95% CI 1.30-4.16) remained risk factors for school age asthma in the infant wheezing group.
Conclusions:
Among infant wheezers, allergic heredity, increased severity of wheeze, infant eczema, and recurrent abdominal pain were independent risk factors for asthma at age 8 yr. Among children with three or four of these risk factors, 38% had asthma at school age.
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