Three-year outcome of a very young severe uncontrolled preschool wheezers cohort, a real-life study

Area of Science:

• Pediatric Pulmonology
• Allergy and Immunology
• Public Health

Background:

• Preschool wheeze represents a significant public health concern, often proving difficult to manage due to the lack of indicated biologic therapies.
• Understanding the long-term evolution and contributing factors of severe preschool wheeze is crucial for developing effective treatment strategies.

Purpose of the Study:

• To investigate the real-life progression of severe preschool wheeze.
• To identify factors associated with persistent, uncontrolled wheezing in young children.
• To analyze the impact of early-life clinical and biological markers on disease trajectory.

Main Methods:

• A retrospective study was conducted at a tertiary asthma center involving children under 3 years with severe, uncontrolled preschool wheeze.
• Data collected included clinical, biological, and radiological examinations, with follow-up assessments at 1, 2, and 3 years post-inclusion.
• 135 patients were included, with outcomes assessed based on disease control status at follow-up points.

Main Results:

• At 3-year follow-up, 29% of patients still experienced severe uncontrolled wheezing.
• Factors associated with uncontrolled wheezing included eosinophils > 0.23G/L and early-onset bronchiolitis (before 2 months) at 1 year.
• Tobacco exposure was linked to uncontrolled wheezing at 2 years, while early bronchiolitis, male sex, and family history of atopy were significant at 3 years.

Conclusions:

• Early-onset bronchiolitis, elevated eosinophil counts, male sex, tobacco exposure, and a family history of atopy are significant predictors of persistent, uncontrolled severe preschool wheeze.
• These findings highlight the complex interplay of factors influencing the long-term prognosis of preschool wheeze.
• The study underscores the need for targeted interventions and further research into the pathophysiology of this condition.