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Published on: August 7, 2017
Sex-specific risk factors for childhood wheeze and longitudinal phenotypes of wheeze
Sze Man Tse1, Sheryl L Rifas-Shiman2, Brent A Coull3
1Division of Respiratory Medicine, Department of Pediatrics, Sainte-Justine University Hospital Center and University of Montreal, Montreal, Quebec, Canada.
Insights
This study found that risk factors for childhood wheeze differ between boys and girls. Paternal asthma strongly predicted wheeze in boys, while other factors like race and breastfeeding were more influential in girls.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Genetics and Epidemiology
Background:
- Sexual dimorphism in wheeze and asthma prevalence is known.
- However, sex-specific risk factors and longitudinal wheeze phenotypes remain unclear.
Purpose of the Study:
- Identify sex-specific risk factors for wheeze from birth to mid-childhood.
- Determine distinct longitudinal wheeze phenotypes.
- Investigate sex-specific predictors for these phenotypes.
Main Methods:
- Utilized a large prebirth cohort with yearly wheeze symptom reporting for 9 years.
- Employed generalized estimating equations, latent class mixed models, and multinomial logistic analysis.
- Analyzed data from 1623 children with wheeze information.
Main Results:
- Paternal asthma was a stronger wheeze predictor in boys than girls.
- Black/Hispanic ethnicity, birth weight z-score, and breastfeeding duration were more associated with wheeze in girls.
- Identified three phenotypes: never/infrequent (74.1%), early transient (12.7%), and persistent (13.1%).
- Paternal asthma predicted persistent wheeze in boys only; Black/Hispanic ethnicity predicted it in girls only.
Conclusions:
- Identified sex-specific predictors for wheeze and its longitudinal patterns.
- Findings may aid in personalized wheeze and asthma treatment strategies.
Background:
Although sexual dimorphism in wheeze and asthma prevalence are well documented, sex-specific risk factors for wheeze and longitudinal wheeze phenotypes have not been well elucidated.
Objective:
By using a large prebirth cohort, this study aimed to identify sex-specific risk factors for wheeze from birth through midchildhood and identify distinct longitudinal wheeze phenotypes and the sex-specific risk factors associated with these phenotypes.
Methods:
Mothers reported child wheeze symptoms over the past year approximately yearly on 9 occasions starting at age 1 year. We identified sex-specific predictors of wheeze, wheeze phenotypes, and sex-specific predictors of these phenotypes by using generalized estimating equations, latent class mixed models, and multinomial logistic analysis, respectively.
Results:
A total of 1623 children had information on wheeze at 1 or more time points. Paternal asthma was a stronger predictor of ever wheezing in boys (odds ratio [OR], 2.15; 95% CI, 1.74-2.66) than in girls (OR, 1.53; 95% CI, 1.19-1.96; P for sex by paternal asthma interaction = .03), whereas being black or Hispanic, birth weight for gestational age z score, and breast-feeding duration had stronger associations among girls. We identified 3 longitudinal wheeze phenotypes: never/infrequent wheeze (74.1%), early transient wheeze (12.7%), and persistent wheeze (13.1%). Compared with never/infrequent wheeze, maternal asthma, infant bronchiolitis, and atopic dermatitis were associated with persistent wheeze in both sexes, but paternal asthma was associated with persistent wheeze in boys only (OR, 4.27; 95% CI, 2.33-7.83; P for sex by paternal asthma interaction = .02), whereas being black or Hispanic was a predictor for girls only.
Conclusion:
We identified sex-specific predictors of wheeze and longitudinal wheeze patterns, which might have important prognostic value and allow for a more personalized approach to wheeze and asthma treatment.
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