Abstract
The distinction between episodic viral wheeze (EVW) and multitrigger wheeze (MTW) is used to guide management of preschool wheeze. It has been questioned whether these phenotypes are stable over time. We examined the temporal stability of MTW and EVW in two large population-based cohorts.
We classified children from the Avon Longitudinal Study of Parents and Children (n=10 970) and the Leicester Respiratory Cohorts ((LRCs), n=3263) into EVW, MTW and no wheeze at ages 2, 4 and 6 years based on parent-reported symptoms. Using multinomial regression, we estimated relative risk ratios for EVW and MTW at follow-up (no wheeze as reference category) with and without adjusting for wheeze severity.
Although large proportions of children with EVW and MTW became asymptomatic, those that continued to wheeze showed a tendency to remain in the same phenotype: among children with MTW at 4 years in the LRCs, the adjusted relative risk ratio was 15.6 (95% CI 8.3–29.2) for MTW (stable phenotype) compared to 7.0 (95% CI 2.6–18.9) for EVW (phenotype switching) at 6 years. The tendency to persist was weaker for EVW and from 2–4 years. Results were similar across cohorts.
This suggests that MTW, and to a lesser extent EVW, tend to persist regardless of wheeze severity.
Abstract
Multitrigger and episodic viral wheeze tend to persist in early childhood and may reflect distinct disease processes http://ow.ly/KQrk30fvXMj
Footnotes
Support statement: This study was supported by the Swiss National Foundation (Grant nos. SNF32003B_162820 and SNF32003B_144068). The UK Medical Research Council and the Wellcome Trust (grant no. 092731) and the University of Bristol provided core support for the ALSPAC (Avon Longitudinal Study of Parents and Children) study. In the Leicester Respiratory Cohort study, data collection was funded by the UK National Asthma Campaign, the University Hospitals of Leicester NHS Trust (R&D), Leicestershire and Rutland Partnership Trust, Medisearch, the Trent NHS Regional Health Authority, and the UK Department of Health. B.D. Spycher is the recipient of a European Respiratory Society (ERS)/Marie Curie Joint Research Fellowship (grant no. MC 1614–2010). The research leading to these results has received funding from the ERS and the European Community's Seventh Framework Programme FP7/2007–2013-Marie Curie Actions under grant agreement RESPIRE, PCOFUND-GA-2008-229571. B.D Spycher also received support from a Swiss National Science Foundation fellowship (grant no. PZ00P3_147987). R. Granell was supported by the UK Medical Research Council (grant no. G0902125). J.A.C. Sterne is funded by the National Institute for Health Research Senior Investigator award NF-SI-0611-10168. The funders had no role in the study design, data collection and analysis, the decision to publish or the preparation of the manuscript. Funding information for this article has been deposited with the Crossref Funder Registry.
Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com
This article has supplementary material available from erj.ersjournals.com
Editorial comment in: Eur Respir J 2017; 50: 1701283.
- Received January 4, 2017.
- Accepted July 29, 2017.
- Copyright ©ERS 2017
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