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Long-term outcome of early childhood wheezing: population data
1St George's Hospital Medical School, London, UK.
Insights
Approximately one quarter of children with early wheezing still wheeze as adults, with risk factors including smoking. Childhood wheezing does not predict adult obstructive lung disease unless symptoms persist.
Area of Science:
- Pediatric Pulmonology
- Adult Respiratory Medicine
- Longitudinal Cohort Studies
Background:
- Early childhood wheezing is a common condition with uncertain long-term outcomes.
- Previous studies have yielded conflicting data on the adult prognosis of childhood wheezing.
Purpose of the Study:
- To review the adult prognosis of early childhood wheezing.
- To identify predictors of persistent wheezing and assess long-term respiratory health in individuals with a history of childhood wheezing.
Main Methods:
- Analysis of data from three population-based cohort studies in Melbourne, Tasmania, and Britain.
- Follow-up of children with a history of asthma or wheezing illness from age 7 into their early thirties.
- Assessment of adult wheezing symptoms, ventilatory function, and bronchial hyperresponsiveness.
Main Results:
- About 25% of children who wheezed in early childhood reported wheezing as adults, with significant variation in severity.
- Remissions and relapses of wheezing were common over a 25-year follow-up period.
- Childhood wheezing resolved in adulthood did not predict adult obstructive lung disease, unlike persistent wheezing which was associated with poorer spirometry and bronchial hyperresponsiveness.
Conclusions:
- Early childhood wheezing has a variable adult prognosis, with a substantial proportion experiencing persistent symptoms.
- Cigarette smoking is a significant risk factor for adult wheezing in those with a history of childhood wheeze.
- Persistent childhood wheezing, bronchial hyperresponsiveness, and reduced ventilatory function in childhood are predictors of adult respiratory issues, suggesting potential progressive deterioration.
Abstract:
The adult prognosis of early childhood wheezing is reviewed using data from three studies (in Melbourne, Tasmania and Britain) which have followed population-based samples of 7 year old children with a history of asthma or wheezing illness into their early thirties. About one quarter of these wheezy children, recruited in the 1960s, reported recent wheeze as adults, but there was considerable variation in the severity of adult wheezing in the three studies. A pattern of remissions and relapses was common over approximately 25 yrs of follow-up. Thus, teenagers who appeared to have outgrown an earlier wheezing tendency remained at risk of future wheezing, particularly if they took up cigarette smoking. Adults who have outgrown their childhood wheezing tendency have ventilatory function similar to healthy controls, suggesting that the abnormalities of neonatal airway function which precede transient wheezing in early childhood do not predict adult obstructive lung disease. In contrast, asthmatic children who continue to wheeze as adults have poorer baseline spirometry than healthy controls, even after inhaled salbutamol. The degree of reduction correlates with the duration and persistence of wheezing. Bronchial hyperresponsiveness and reduced levels of ventilatory function in childhood predict both persistence of wheeze and level of bronchial responsiveness in adult life. These may simply be markers of disease severity, but there is evidence of progressive deterioration of ventilatory function through adolescence in children with persistent symptoms. These progressive changes may underlie the observed association between chest illness in childhood and later adult life.