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Published on: August 7, 2017
Preschool Wheeze Profiles and Early Life Associations: An Australian Prebirth Cohort
Rachel J Morgan1,2, Xin Dai3, Caroline J Lodge3
1Institute of Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia.
Insights
Four preschool wheeze profiles were identified, with maternal asthma and lack of breastfeeding being key risk factors. These profiles impact wheeze risk later in childhood.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Epidemiology
Background:
- Wheezing in early childhood is common but heterogeneous.
- Identifying distinct wheeze phenotypes is crucial for understanding underlying mechanisms and developing targeted interventions.
- Prospective cohort studies are essential for tracking wheeze trajectories and associated risk factors from infancy through childhood.
Purpose of the Study:
- To define distinct wheeze profiles in preschool children up to 4 years of age.
- To identify early-life factors associated with these wheeze profiles.
- To determine the impact of these preschool wheeze profiles on the risk of wheezing at 9 years of age.
Main Methods:
- Latent class analysis was used to identify wheeze profiles based on eight wheeze responses and two severity markers from infancy to 4 years.
- Data were drawn from a pre-birth prospective cohort study.
- Multinomial logistic regression was employed to calculate relative risk ratios (RRR) for associations between early-life risk factors and wheeze at 9 years.
Main Results:
- Four preschool wheeze profiles were identified: 'never/infrequent' (n=538), 'early persistent' (n=83), 'transient' (n=263), and 'late-onset' (n=148).
- Maternal asthma history increased the risk for all adverse wheeze profiles, particularly 'early persistent' wheeze (RRR 5.06).
- Breastfeeding at 6 months reduced 'early persistent' wheeze risk (RRR 0.53), and at 12 months protected against all adverse profiles. Eczema and allergies increased the risk of 'early persistent' and 'late-onset' wheeze. 'Early persistent' (RRR 7.25) and 'late-onset' (RRR 3.93) wheeze profiles were associated with increased wheeze risk at 9 years.
Conclusions:
- Distinct preschool wheeze profiles are associated with specific early-life exposures and atopy measures.
- Maternal asthma and the absence of breastfeeding are significant unifying risk factors for adverse wheeze profiles.
- Further research into underlying mechanisms is necessary to develop effective primary prevention strategies for childhood wheeze.
Aim:
To define preschool wheeze profiles to 4-years, identify their early life associations, and impact on wheeze risk at 9-years.
Methods:
A latent class analysis of eight wheeze responses (1 month-4 years) and two severity markers (respiratory presentation to emergency department and wheeze with shortness of breath) using data from a pre-birth prospective cohort study. Relative risk ratios (RRR) with 95% confidence intervals were calculated using multinomial logistic regression to examine associations between early life risk factors and wheeze at 9-years.
Results:
Four distinct preschool wheeze profiles were identified: "never/infrequent" with minimal wheeze (n = 538), "early persistent" wheeze from 3 months to 4 years (n = 83), "transient" from 6 to 18 months (n = 263) and "late-onset" from 18 months to 4 years (n = 148). Relative to "never/infrequent", maternal asthma history was associated with increased risk of all adverse wheeze profiles, the highest for "early persistent" wheeze [RRR 5.06; 2.96-8.67]. Breastfeeding at 6 months decreased the risk of "early persistent" wheeze [RRR 0.53; 0.31-0.90] and at 12 months protected against all adverse wheeze profiles. Eczema, food allergy, aeroallergen and food sensitisation all increased the risk of "early persistent" and "late-onset" wheeze. "Early persistent" [RRR 7.25; 3.92-13.42] and "late-onset" [RRR 3.93; 2.24-6.89] wheeze profiles were associated with increased risk of wheeze at 9-years.
Conclusions:
Early life exposures and atopy measures had distinct associations with data-derived preschool wheeze profiles. Maternal asthma and the absence of breastfeeding emerged as unifying risk factors. Investigation of the underlying mechanistic pathways is required to inform novel primary prevention strategies.
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