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A study of etiology and asthma risks in infants and toddlers hospitalized for recurrent or persistent wheezing

Qiuwei Yi1, Shanshan Liu2, Jingjing Qiao2

  • 1Respiratory Department, Beijing Children Hospital, Capital Medical University, China National Clinical Research Center of Respiratory Diseases, National Center for Children Health, Beijing, China.

Frontiers in Pediatrics
|April 15, 2025
PubMed

Insights

Recurrent and persistent wheezing in infants have different causes, with viral infections common in recurrent cases and protracted bacterial bronchitis in persistent ones. Key risk factors for infantile asthma include older age, ICU admission, positive modified Asthma Prediction Index (mAPI), and food allergy.

Area of Science:

  • Pediatric Pulmonology
  • Respiratory Medicine
  • Allergy and Immunology

Background:

  • Recurrent and persistent wheezing are common in infants and toddlers, presenting diagnostic challenges.
  • Identifying the specific etiology is crucial for effective management and differentiating conditions like infantile asthma.

Purpose of the Study:

  • To investigate the distinct etiologies of recurrent versus persistent wheezing in young children.
  • To identify significant risk factors associated with the development of infantile asthma.

Main Methods:

  • Retrospective analysis of clinical, laboratory, imaging, and lung examination data from 612 children (0-36 months) hospitalized for wheezing.
  • Comparative analysis between groups and multivariate logistic regression to determine asthma risk factors.
  • Bronchoscopy performed on 181 children to assess airway pathology.

Main Results:

  • Etiologies differed significantly: viral infections (48.4%) and infantile asthma (28.0%) were top causes for recurrent wheezing, while protracted bacterial bronchitis (PBB; 67.5%) and tracheomalacia (22.2%) predominated in persistent wheezing.
  • Bronchoscopy revealed purulent changes (34.3%), tracheomalacia (27.1%), and positive bronchoalveolar lavage fluid (25.4%).
  • Older age, ICU admission, positive modified Asthma Prediction Index (mAPI; OR 4.066), and food allergy were identified as risk factors for asthma, with an AUC of 0.8016 for prediction.

Conclusions:

  • Wheezing phenotype and age can guide etiological diagnosis in infants and young children.
  • Bronchoscopy is valuable for refractory cases, and mAPI aids in asthma diagnosis.
  • Consider asthma in infants with recurrent/persistent wheezing, older age, ICU admission, positive mAPI, and food allergy.
Abstract

Keywords:
etiologyinfantile asthmainfantspersistent wheezingrecurrent wheezingrisk factorsyoung children

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