Paul IM, Camera L, Zeiger RS, Guilbert TW, Bacharier LB, Taussig LM, Morgan WJ, Covar RA, Krawiec M, Bloomberg GR, Mauger DT, for the Childhood Asthma Research and Education (CARE) Network. Relationship between infant weight gain and later asthma.
Pediatr Allergy Immunol 2010: 21: 82–89.
© 2009 John Wiley & Sons A/S Like obesity, the prevalence of asthma has increased over the past several decades. Accelerated patterns of infant growth have been associated with obesity and its co‐morbidities. We aimed to determine if infant weight gain pattern is associated with asthma development later in childhood. Birth weight, growth, pulmonary function, and symptom data were collected in a trial of 2‐ to 3‐yr‐old children at‐risk for asthma randomized to a 2‐yr treatment with inhaled corticosteroids or placebo followed by a 1‐yr observation period of study medication. Patterns of infant weight gain between birth and study enrollment were categorized as accelerated, average, or decelerated. Regression analyses were used to test the effects of infant weight gain pattern prior to study enrollment on outcomes during the observation year and at study conclusion while adjusting for demographics, baseline symptom severity, study treatment, and atopic indicators. Among the 197 study participants, early life weight gain pattern was not associated with daily asthma symptoms or lung function at the study’s conclusion. However, both prednisone courses (p = 0.01) and urgent physician visits (p < 0.001) were significantly associated with weight gain pattern with fewer exacerbations occurring amongst those with a decelerated weight gain pattern. We conclude that early life patterns of weight change were associated with subsequent asthma exacerbations, but were not associated with asthma symptoms or pulmonary function during the pre‐school years for these children at‐risk for asthma.

Objectives To examine parent-observed signs and symptoms as antecedents of wheezing in preschool children with prior moderate to severe wheezing episodes, as well as to determine the predictive capacity of these symptom patterns for wheezing events. Study Design Parents (n = 238 ) of children 12–59 months of age with moderate-to-severe intermittent wheezing enrolled in a year-long clinical trial completed surveys that captured signs and symptoms at the start of respiratory tract illnesses. Sensitivity, specificity, negative predictive value, and positive predictive values for each symptom leading to wheezing during that respiratory tract illness were calculated. Results The most commonly reported first symptom categories during the first respiratory tract illness were “nose symptoms” (41%), “significant cough” (29%), and “insignificant cough” (13%). The most reliable predictor of subsequent wheezing was “significant cough”, which had specificity of 78% and positive predictive value of 74% for predicting wheezing. Conclusions “Significant cough” is the most reliable antecedent of wheezing during a respiratory tract illness. It may be useful to consider individualized symptom patterns as a component of management plans intended to minimize wheezing episodes.