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Recurrent wheezing phenotypes after severe bronchiolitis and progression to asthma

Jonathan M Mansbach1, Qi Shelly Ying2, Janice A Espinola2

  • 1Department of Pediatrics, Boston Children's Hospital, Boston.

The Journal of Allergy and Clinical Immunology. Global
|April 3, 2023
PubMed

Insights

Severe wheezing phenotypes in infants hospitalized for bronchiolitis are linked to childhood asthma. Depending on the specific wheezing phenotype, 33% to 54% of children may develop asthma by age 6.

Area of Science:

  • Pediatric Respiratory Medicine
  • Asthma Research
  • Clinical Cohort Studies

Background:

  • Recurrent wheezing is a common diagnosis following severe bronchiolitis in infants.
  • The relationship between different recurrent wheezing phenotypes and the development of childhood asthma remains unclear.

Purpose of the Study:

  • To investigate the association between three recurrent wheezing phenotypes defined in 2020 and the subsequent development of asthma by age 6.
  • To compare these phenotypes with the 2007 National Heart, Lung, and Blood Institute (NHLBI) recurrent wheezing definition.

Main Methods:

  • A 17-center cohort study involving infants hospitalized with bronchiolitis.
  • Phenotyping of recurrent wheezing (NHLBI 2020, multitrigger, severe) by age 4 and assessment for asthma by age 6.
  • Multivariable logistic regression analysis to identify characteristics of high-risk phenotypes.

Main Results:

  • By age 4, a majority of infants met criteria for NHLBI 2020 recurrent wheezing (69%), multitrigger wheezing (80%), or severe wheezing (18%).
  • By age 6, 28% of children developed asthma.
  • The proportion of children who developed asthma varied by phenotype: 33% for NHLBI 2020 and multitrigger wheezing, and 54% for the severe phenotype.

Conclusions:

  • Infants with severe bronchiolitis frequently develop recurrent wheezing phenotypes by age 4.
  • A significant proportion of children, ranging from 33% to 54%, may progress to asthma by age 6, with the severe phenotype posing the highest risk.
  • Further research is needed to explore early interventions for high-risk wheezing phenotypes to potentially prevent childhood asthma.
Abstract

Keywords:
Bronchiolitisasthmacohort studyinfantsrecurrent wheezing

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