Wheezing and bronchial hyper-responsiveness in early childhood as predictors of newly diagnosed asthma in early adulthood: a longitudinal birth-cohort study.

Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA.
The Lancet (Impact Factor: 45.22). 10/2008; 372(9643):1058-64. DOI: 10.1016/S0140-6736(08)61447-6
Source: PubMed

ABSTRACT Incidence of asthma increases during early adulthood. We aimed to estimate the contributions of sex and early life factors to asthma diagnosed in young adults.
1246 healthy newborn babies were enrolled in the Tucson Children's Respiratory Study. Parental characteristics, early-life wheezing phenotypes, airway function, and bronchial hyper-responsiveness to cold dry air and sensitisation to Alternaria alternata were determined before age 6 years. Physician-diagnosed asthma, both chronic and newly diagnosed, and airway function were recorded at age 22 years.
Of 1246 babies enrolled, 849 had follow-up data at 22 years. Average incidence of asthma at age 16-22 years was 12.6 per thousand person-years. 49 (27%) of all 181 cases of active asthma at 22 years were newly diagnosed, of which 35 (71%) were women. Asthma remittance by 22 years was higher in men than in women (multinomial odds ratio [M-OR] 2.0, 95% CI 1.2-3.2, p=0.008). Age at diagnosis was linearly associated with the ratio of forced expiratory volume at 1 s to forced vital capacity at age 22 years. Factors independently associated with chronic asthma at 22 years included onset at 6 years (7.4, 3.9-14.0) and persistent wheezing (14.0, 6.8-28.0) in early life, sensitisation to A alternata (3.6, 2.1-6.4), low airway function at age 6 years (2.1, 1.1-3.9), and bronchial hyper-responsiveness at 6 years (4.5, 1.9-10.0). Bronchial hyper-responsiveness (6.9, 2.3-21.0), low airway function at 6 years (2.8, 1.1-6.9), and late-onset (4.6, 1.7-12.0) and persistent wheezing (4.0, 1.2-14.0) predicted newly diagnosed asthma at age 22 years.
Asthma with onset in early adulthood has its origins in early childhood.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Viral aetiology, host susceptibility (in particular allergic predisposition and sensitization), and illness severity, timing and frequency all appear to contribute as synergistic factors to the risk of developing asthma. Experimental models have shown both innate and adaptive immune responses contribute to this risk with lung inflammatory cells showing marked differences in phenotype and function in young compared with older animals, and these differences are further enhanced following virus infection. Findings to date strongly suggest that the impact of infant and preschool viral infections on the maturing immune system and developing lung that subsequently result in an asthma phenotype occur during a critical susceptibility period, and in a genetically susceptible host. There are currently no therapeutic strategies that allow primary or secondary prevention of asthma following early life viral respiratory infections in high-risk children, thus a focus on understanding the mechanisms of progression from viral wheezing in infants and preschool children to asthma development are urgently needed. This review summarizes the data reporting the role of the two most common viruses, that is, respiratory syncytial virus and human rhinovirus, that result in asthma development, comparing risk factors for disease progression, and providing insight into strategies that might be adopted to prevent asthma development.
    08/2013; 1(4):139-150. DOI:10.1177/2049936113497202
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Asthma and other wheezing disorders are very common in preschool children and its approach is difficult due to the paucity of symptoms implying different causes and different prognosis. Over the last decades, findings from prospective cohort studies such as the Tucson Children’s Respiratory Study have improved our understanding of this frequent disorder. These large cohorts helped identify different wheezing phenotypes, and led to a better understanding of the interplay between genetic, environmen tal and developmental factors. In spite of that, uncertainty still persists regarding diagnosis and treatment of wheezing in preschool children, especially when applying current knowledge to individual children. Long-term prognosis varies from complete recovery in most cases, to asthma or permanent lung function impairment. Here we review the epidemiology of wheezing in preschool children, the different phenotypes and risk factors, and the difficulties of its diagnostic approach. The most frequent causes of wheezing in preschool children include recurrent or persistent wheezing with atopy and progression to asthma, and transient wheezing related to viral infections. This seems to be the most useful classification of wheezing phenotypes.
  • Source


Available from