Severe intermittent wheezing in preschool children: A distinct phenotype

Department of Pediatrics, Washington University in St. Louis, San Luis, Missouri, United States
Journal of Allergy and Clinical Immunology (Impact Factor: 11.48). 03/2007; 119(3):604-10. DOI: 10.1016/j.jaci.2006.12.607
Source: PubMed


Young children with wheezing predominantly with respiratory tract illnesses experience severe exacerbations separated by extended periods of wellness and may be described as having "severe intermittent wheezing," a diagnostic category not currently recognized in national guidelines.
We sought to characterize a cohort of children with recurrent severe wheezing.
A total of 238 children 12 to 59 months enrolled in the Acute Intervention Management Strategies trial were characterized through comprehensive allergy, asthma, environmental, and quality of life assessments.
Asthma symptoms over the period of the preceding year occurred at frequencies consistent with intermittent asthma, as 94.5% of children experienced activity limitation < or = 2 times per month. However, frequent severe exacerbations were common, because 71% experienced > or = 4 wheezing episodes over the period of the preceding year, 95% made at least 1 primary care visit, 52% missed school or daycare, 40% made an emergency department visit, and 8% were hospitalized for wheezing illnesses. Atopic features were common, including eczema (37%), aeroallergen sensitization (46.8%), and positive asthma predictive index (59.7%). Oral corticosteroid use in the previous year (59.7% of the cohort) identified a subgroup with more severe disease documented by a higher incidence of urgent care visits (P = .0048), hospitalizations (P = .0061), aeroallergen sensitization (P = .047), and positive asthma predictive indices (P = .007).
Among preschool children enrolled in the Acute Intervention Management Strategies trial, a subgroup was identified with severe intermittent wheezing characterized by atopic features and substantial illness-related symptom burden despite prolonged periods of wellness.
Preschool children with recurrent severe wheezing episodes experience significant illness-related morbidity and exhibit features of atopic predisposition.

6 Reads
  • Source
    • "The common perception that EVW has a high likelihood of spontaneous resolution over time is based on general population studies which examined the outcome of wheeze in children who had at least one episode of (usually mild) wheezing [7]. Preschool children with more frequent or more severe episodes of wheezing are more likely to develop asthma than children with mild or isolated episodes of wheeze in early life [4, 9, 10, 23]. Clinical studies on the outcome of more severe wheeze in early childhood are rare, however. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In population studies, most children with episodic viral wheeze (EVW) become symptom free by 6 years. We studied the outcome of children with severe EVW, treated and followed up in hospital. We followed up 78 children <4 years, managed by paediatricians for severe EVW, to the age of 5-10 years. We recorded respiratory symptoms, spirometry and exhaled nitric oxide (FeNO). At follow-up, 42 children (54%) had current wheeze or dyspnoea, and 52 (67%) had current asthma. There was no significant difference between children with and without current asthma in FEV1 (p = 0.420), but FeNO was higher in children with current asthma (median (interquartile range) 14.5 (11.25-21.50) ppb) than in those without (12.0 (10.0-13.8) ppb, p = 0.020). Positive family history of asthma was the only factor associated with current asthma (odds ratio 8.77, 95% CI 2.88-26.69, p < 0.001). This remained significant after adjustment for duration of follow-up, gender and parental smoking. Conclusion. Severe EVW at preschool age has a high risk of asthma at age 5-10 years, and this is reinforced by a positive family history of asthma and to elevated FeNO levels.
    European Journal of Pediatrics 01/2012; 171(6):947-54. DOI:10.1007/s00431-011-1663-7 · 1.89 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Processing of Gallium Arsenide MMIC's is expensive due in part to the time required to RF-qualify wafers. Manufacturers who intend to compete in this relatively new market must reduce device costs. To reduce a MMIC's cost a major emphasis should be on early detection and discontinuation of wafers which will not yield devices meeting the MMIC's expected RF performance. On-wafer RF qualification can be established as a technique to achieve this goal.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Asthma is the leading chronic disease among children in most industrialized countries. However, the evidence base on specific aspects of pediatric asthma, including therapeutic strategies, is limited and no recent international guidelines have focused exclusively on pediatric asthma. As a result, the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology nominated expert teams to find a consensus to serve as a guideline for clinical practice in Europe as well as in North America. This consensus report recommends strategies that include pharmacological treatment, allergen and trigger avoidance and asthma education. The report is part of the PRACTALL initiative, which is endorsed by both academies.
    Allergy 02/2008; 63(1):5-34. DOI:10.1111/j.1398-9995.2007.01586.x · 6.03 Impact Factor
Show more

Similar Publications