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The analysis of risk factors for recurrent wheezing in infants and clinical intervention
Liting Geng1, Xiaoyu Tang1, Li Hua1
1Department of Pediatric Respiratory, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
Insights
Recurrent wheezing in infants is linked to male sex, allergies, and infections. Long-term inhaled corticosteroid treatment can effectively reduce recurrent wheezing in at-risk children.
Area of Science:
- Pediatric Respiratory Medicine
- Allergy and Immunology
- Public Health
Background:
- Recurrent wheezing in infants is a significant precursor to childhood asthma.
- Current diagnostic criteria and interventions for infant recurrent wheezing lack standardization.
- Identifying risk factors and effective interventions is crucial for individualized treatment and disease prevention.
Purpose of the Study:
- To analyze risk factors associated with recurrent wheezing in infants.
- To evaluate the effectiveness of different intervention strategies for managing recurrent wheezing.
- To provide evidence for individualized treatment plans to reduce the incidence of recurrent wheezing.
Main Methods:
- Retrospective analysis of 523 children under 3 years old hospitalized with initial wheezing episodes.
- Data collection included demographic characteristics, clinical history, and post-discharge outcomes via telephone questionnaires.
- Statistical analysis, including chi-squared tests, multivariate analysis, and Cox survival curves, was employed.
Main Results:
- Nearly half (49.5%) of hospitalized infants experienced recurrent wheezing post-discharge.
- Identified risk factors for recurrent wheezing include male sex, history of eczema/rhinitis, prior wheezing, smoke exposure, Mycoplasma infection, and allergen sensitization.
- A significant interaction was observed between Mycoplasma infection and inhalation allergy history.
Conclusions:
- Male infants with a history of eczema, rhinitis, prior wheezing, smoke exposure, Mycoplasma infection, or allergies face higher risks of recurrent wheezing.
- Long-term interventions (≥4 weeks) post-discharge are effective in reducing recurrent wheezing.
- Long-term inhaled corticosteroids (ICS) are particularly effective for male infants with a history of eczema or rhinitis to prevent recurrent wheezing.
Background:
Asthma is one of the most common chronic diseases affecting children's health, and recurrent wheezing in infants is closely related to childhood asthma. However, up to now, there is a lack of unified diagnostic criteria and interventions for recurrent wheezing in infants. By analyzing and discussing the risk factors of recurrent wheezing in infants and related intervention measures, we aim to take individualized treatment for different children and reduce the occurrence of recurrent wheezing in infants.
Methods:
From January 2017 to December 2020, children under 3 years old who were admitted to the Department of Pediatric Respiratory of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine with the chief complaint of wheezing for the first time and were clinically diagnosed with bronchiolitis, asthmatic bronchopneumonia and asthmatic bronchitis were retrospectively analyzed through telephone questionnaires. These children were divided into two groups based on whether the wheezing occurred again after discharge. The demographic characteristics, clinical treatment, imaging characteristics, and related interventions and outcomes after discharge were analyzed in both groups.
Results:
Among the 523 children under 3 years old who were hospitalized due to wheezing, 264 (50.5%) did not have wheezing after discharge, and 259 (49.5%) still had wheezing after discharge. Both chi-squared test and multivariate analysis showed that male, history of eczema, history of rhinitis, history of wheezing before hospitalization, family smoke exposure, mycoplasma infection and inhalation allergen sensitization were risk factors for recurrent wheezing in infants and young children (P<0.05). Simultaneously, Cox survival curve showed that different intervention time and intervention methods would lead to different prognosis.
Conclusions:
(I) Male, with a history of eczema, rhinitis, wheezing before hospitalization, family environment smoke exposure, mycoplasma infection and a history of inhalation allergy are high risk factors for recurrent wheezing in the recurrent wheezing group, and are more likely to have recurrent wheezing after discharge, with shorter days of wheezing control; (II) there was a significant interaction between mycoplasma infection and a history of inhalation allergy in infants with the risk of recurrent wheezing; (III) long-term intervention for children with wheezing for 4 weeks or more after discharge can reduce the probability of recurrent wheezing; (IV) for children of male, with a history of eczema or rhinitis, the most effective intervention to reduce the probability of recurrent wheezing is long-term inhaled corticosteroids (ICS) treatment after discharge.
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