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The natural history of respiratory symptoms in preschool children
A M Brooke1, P C Lambert, P R Burton
1Department of Child Health, University of Leicester, England.
Insights
Many preschool children with respiratory symptoms improve, but persistent wheeze indicates asthma. Early wheezing in children is linked to higher bronchial responsiveness and atopy, suggesting asthma development.
Area of Science:
- Pediatric Respiratory Medicine
- Epidemiology of Childhood Illnesses
- Allergy and Immunology
Background:
- Preschool respiratory symptoms are common but their natural history is not fully understood.
- Identifying predictors of persistent symptoms is crucial for early diagnosis and management.
- Understanding the transition of respiratory symptoms from preschool to school age informs clinical practice.
Purpose of the Study:
- To investigate the natural history of preschool respiratory symptoms into early school years.
- To assess ventilatory function, bronchial responsiveness, atopic status, and peak expiratory flow variability.
- To identify characteristics associated with persistent respiratory symptoms in children.
Main Methods:
- Population-based cohort study of children followed from preschool into early school years.
- Assessment of current respiratory symptoms, ventilatory function, bronchial responsiveness to methacholine (BR), atopic status, and peak expiratory flow variability (PEFV).
- Analysis of symptom transition and clinical characteristics based on initial symptom group (asymptomatic, wheeze, cough).
Main Results:
- Among asymptomatic children, most remained symptom-free; some developed wheeze or cough.
- Nearly half of preschool wheezers became symptom-free, while others continued to wheeze or developed cough.
- Preschool wheezers exhibited significantly higher bronchial responsiveness (BR) and atopic prevalence (AP) compared to asymptomatic and cough groups.
- Persistent wheeze was associated with poorer ventilatory function, higher BR, high AP, and high PEFV.
Conclusions:
- Fewer than half of preschool wheezy children have persistent wheeze in early school years.
- Children with persistent wheeze show clinical features consistent with asthma.
- Early wheezing, high bronchial responsiveness, and atopy are indicators for potential asthma development.
Abstract:
We studied the natural history of preschool respiratory symptoms in a population-based sample of children followed during the early school years. Current symptoms, ventilatory function, bronchial responsiveness to methacholine (BR), atopic status, and peak expiratory flow variability (PEFV) were assessed. Among those initially asymptomatic (210 subjects), 83.3% remained symptom-free, 6.7% started to wheeze, and 10% developed recurrent cough. Nearly half (46.9%) of the initial wheezing group (145 subjects) became symptom-free, 37.9% continued to wheeze, and 15.2% reported recurrent cough. Over half (56.0%) of the cough group (127 subjects) became symptom-free, 7.2% developed wheeze, and 36.8% reported continuing cough. Preschool wheezers showed the greatest BR (geometric mean 1.91 mg/ml) and the highest atopic prevalence (AP) (43.6%) when compared with the preschool asymptomatic group (BR: 3.39 mg/ml; AP: 23.8%) and the cough group (BR: 2.62 mg/ml; AP: 26.7%) (p = 0.0001 and p = 0.006 respectively). Children whose wheeze had persisted from the preschool period exhibited the poorest ventilatory function, the highest BR, a high AP, and high PEFV. The study shows that fewer than half of preschool wheezy children continued to wheeze in the early school years but those with persistent wheeze display many of the clinical characteristics consistent with a diagnosis of asthma.