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Published on: August 7, 2017
Factors and mechanisms contributing to the development of preschool wheezing disorders
Katie Bonner1,2, Elizabeth Scotney1,2, Sejal Saglani1,2
1Inflammation, Repair & Development Section, National Heart & Lung Institute, Imperial College London, London, UK.
Insights
Wheezing affects half of young children, leading to hospitalizations and lifelong lung issues. Understanding early life factors is key to preventing persistent wheezing and improving respiratory health outcomes.
Area of Science:
- Pediatric Pulmonology
- Immunology
- Environmental Health
Background:
- Wheezing is common in children, with preschool episodes causing most childhood hospital admissions.
- Recurrent wheezing in early life is linked to diminished lung function and long-term respiratory health problems.
Purpose of the Study:
- To review literature on factors influencing wheeze onset and persistence in children.
- To focus on mechanistic studies examining early life exposures and immune responses in susceptible children.
Main Methods:
- Literature review of PubMed from August 2010-2020.
- Emphasis on mechanistic studies investigating early allergen sensitization, infections, and environmental impacts on the airway microbiome and immune responses.
Main Results:
- Associative data highlight the influence of prenatal and postnatal factors on wheeze development.
- Mechanistic insights into how early exposures shape immune responses are discussed.
Conclusions:
- More mechanistic and biomarker-based interventional studies are needed.
- Targeted interventions are crucial to reduce the healthcare burden of preschool wheezing disorders.
Introduction:
Half of all children will experience an episode of wheezing by their sixth birthday and acute episodes of wheezing in preschool children account for the majority of all childhood hospital admissions for wheeze. Recurrent preschool wheezing associates with early loss of lung function and a life-long impact on lung health.
Areas Covered:
We reviewed the literature on PubMed from August 2010-2020 focussing on factors associated with wheeze inception and persistence, paying specific attention to mechanistic studies that have investigated the impact of early life exposures in shaping immune responses in children with underlying susceptibility to wheezing. In particular, the role of early allergen sensitization, respiratory infections, and the impact of the environment on shaping the airway microbiome and resulting immune responses are discussed.
Expert Opinion:
There is an abundance of associative data showing the role of in utero and postnatal factors influencing wheeze onset and persistence. However, mechanistic and stratified, biomarker-based interventional studies that confirm these associations are now needed if we are to impact the significant healthcare burden resulting from preschool wheezing disorders.
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