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Childhood wheeze raises asthma risk in adolescence

Participants in a pediatric asthma prevention study who developed transient early, late onset or persistent wheeze in childhood were more likely to develop asthma and airway hyperresponsiveness at age 15 years, according to recent research.

“Although we could not classify more recently defined phenotypes requiring data between ages 2 years and 7 years, our results are consistent with other cohorts where children experiencing intermediate, late-onset, and persistent wheeze were more likely to develop asthma and bronchial hyperreactivity by middle childhood,” Meghan B. Azad, PhD, of the department of pediatrics and child health at University of Manitoba in Winnipeg, Canada, and colleagues wrote. “Our study extends these findings through adolescence in a high-risk cohort and demonstrates that asthma-associated deficits in lung function are already present at a young age. Collectively, these data show that early wheezing patterns provide clinically meaningful information and suggest that strategies to reduce early-life wheezing and atopic sensitization could have long-term health benefits.”

Azad and colleagues evaluated 320 participants aged 15 years from the Canadian Asthma Primary Prevention Study. They analyzed wheeze phenotypes from data previously collected in the study at 4-month follow-up points between ages 4 months and 2 years and again at age 7 years. Researchers established three phenotypes for wheeze: transient early wheeze (wheezing before age 3, but not at age 6), late onset wheeze (wheezing at age 6, but not before age 3) and persistent wheeze (wheezing before age 3 and at age 6).

Fifty-one percent of participants were categorized as never developed wheeze, 27.7% had transient early wheeze, 8.9% had late onset wheeze and 12.9% had persistent wheeze. Researchers observed a strong association between atopy prior to age 2 years and persistent wheeze (P < .001). Participants who never had wheeze had significantly higher rates of FEV₁ compared with participants with transient early wheeze (−219 mL; P = .007), late onset wheeze (−304 mL; P = .01) and persistent wheeze (−335 mL; P = .001).

The prevalence of asthma was greater among participants with wheeze, with 5% of participants who never developed wheeze, 19% of participants who had transient early wheeze (OR = 3.94 95% CI, 1.59-9.78), 27% of participants with late onset wheeze (OR = 6.01; 95% CI, 1.96-18.39) and 42% of participants with persistent wheeze (OR = 11.81; 95% CI, 4.45-31.35) developing asthma at age 15 years.

Additionally, food allergy carried an elevated risk for late onset wheeze (adjusted OR = 5.58; 95% CI, 1.56-19.96) but not transient early wheeze. Researchers also observed an increased risk for wheeze and airway hyperresponsiveness at age 15 years for those participants with late onset and persistent wheeze, but not early transient wheeze.

Azad and colleagues reported no associations between wheeze and atopic dermatitis or allergic rhinitis. – by Jeff Craven

Disclosure: The researchers report no relevant financial disclosures.