Risk factors for recurrent attacks of wheeze in preschool children: a population-based cohort study in England

Area of Science:

• Pediatric respiratory medicine
• Epidemiology
• Health informatics

Background:

• Recurrent acute wheeze is a common concern in preschool children, impacting healthcare resource utilization.
• Identifying predictive factors for recurrent wheeze is crucial for targeted interventions and improved clinical management.

Purpose of the Study:

• To identify demographic and clinical factors associated with recurrent acute wheeze attacks in preschool children.
• To inform clinical risk prediction models for preschool wheeze exacerbations.

Main Methods:

• Retrospective cohort study utilizing English primary care and hospital electronic health records.
• Analysis of 42,820 children aged 5 years or under with at least one acute wheeze presentation.
• Multivariable analyses of demographic, clinical comorbidities, medication history, and prior attack data.

Main Results:

• Approximately 40% of children experienced a subsequent wheeze attack within 12 months.
• Strongest predictors for recurrent attacks included hospitalization for the initial episode (RR 1.42) and a prior attack (RR 1.27).
• Other significant factors included male sex, South Asian ethnicity, atopy, prematurity, increased reliever prescriptions, and previous hospitalizations; older age and inhaled corticosteroid use were protective.

Conclusions:

• Clinical risk prediction for recurrent wheeze in preschool children can be enhanced by considering factors such as prior hospitalizations, previous attacks, and medication history.
• These findings support the development of targeted strategies to manage and prevent recurrent wheeze exacerbations in young children.