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Predicting persistent disease among children who wheeze during early life

¹ The David Hide Asthma & Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight and ² Respiratory Cell and Molecular Biology, School of Medicine, Southampton General Hospital, Southampton, UK

CORRESPONDENCE: S.H. Arshad, The DavidHide Asthma & Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, PO30 5TG, UK. Fax: 44 1983822928. E-mail: sha@soton.ac.uk

Keywords: atopy, childhood asthma, persistent wheezing, risk factors, risk score

Received: January 16, 2003
Accepted May 28, 2003

This study was funded by the National Asthma Campaign, UK, grant number 364. The 10-yr follow-up was also funded with their assistance.

This study sought to determine factors influencing the persistence of early life wheezing up to the age of 10 yrs and to create a score identifying those with the highest risk of persistent disease.

Children were seen at birth, 1, 2, 4 and 10 yrs in a whole population birth cohort study (n=1,456). Information was collected prospectively on wheeze prevalence and subjects were classified into wheezing phenotypes. Early life genetic and environmental risk factors were recorded and skin-prick testing (SPT) was performed at 4 yrs. Independently significant factors for persisting wheeze were identified at logistic regression and used to create a score for persistence.

Wheezing persistence from the first 4 yrs to the age of 10 yrs occurred in 37% of early life wheezers. Independent significance for persistence was associated with asthmatic family history, atopic SPT at 4 yrs and recurrent chest infections at 2 yrs, whilst recurrent nasal symptoms at 1 yr conferred reduced risk. A cumulative risk score using these factors identified wheezing persistence in 83% scoring 4 and transience in 80% scoring 0.

Thus, a combination of genetic predisposition, early life atopy and recurrent chest infections favours the persistence of early life wheezing. Risk scores using such knowledge could provide prognostic guidance on the outcome of early wheeze.

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