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Types of asthma and wheezing
1Respiratory Sciences Center, College of Medicine, The University of Arizona, Tucson 85724, USA.
Insights
Childhood asthma is a spectrum of conditions. Early wheezing often resolves, but persistent asthma in children may be linked to genetics, allergies, and distinct immune responses to viruses.
Area of Science:
- Pediatric Pulmonology
- Allergology
- Immunology
Background:
- Childhood asthma presents as a spectrum of conditions characterized by recurrent bronchial obstruction.
- Differentiating various
Purpose of the Study:
- To explore the spectrum of childhood asthma and identify factors differentiating transient from persistent wheezing syndromes.
- To highlight the need for early identification of inflammatory markers for effective asthma prevention strategies.
Main Methods:
- Review of existing evidence on childhood asthma and wheezing syndromes.
- Analysis of risk factors including age, genetics, birth maturation, and allergic sensitization.
- Comparison of immune responses to viral infections in transient versus persistent wheezers.
Main Results:
- Recurrent obstructive symptoms in early childhood (first 3 years) often remit, with low lung function as a key risk factor for transient episodes.
- Persistent wheezing beyond infancy is associated with a family history of asthma and allergies, and early allergic symptoms.
- Children with persistent wheezing exhibit distinct acute immune responses to viruses compared to transient wheezers.
Conclusions:
- Childhood asthma is heterogeneous, with distinct phenotypes for transient and persistent wheezing.
- Early identification of inflammatory markers in lower respiratory symptoms is crucial for developing future asthma prevention strategies.
Abstract:
There is now convincing evidence that childhood asthma is a spectrum of different conditions that are manifested by recurrent symptoms of bronchial obstruction. Risk factors such as age, genetic background, degree of maturation at birth and allergic sensitization, amongst others, are important in determining asthma-like manifestations at different times during childhood. Although efforts have been made to differentiate "wheezing syndromes" occurring during childhood, these efforts have been made more difficult by the significant degree of overlap between them. Nevertheless, the evidence suggests that recurrent obstructive symptoms remit in a large number of children who develop these symptoms during the first 3 yrs of life, and low lung function seems to be the main risk factor for these transient episodes. On the other hand, children who will go on to develop persistent wheezing beyond infancy and early childhood usually have a family history of asthma and allergies and present with allergic symptoms very early in life. Recent studies suggest that the latter also show acute immune responses to viruses that are different from those of transient wheezers. Identification of specific inflammatory markers for persistent wheezing at the time of the first lower respiratory symptoms may be a necessary step for the establishment of successful strategies for the prevention of asthma in the future.