Characteristics and prognosis of hospital‐treated obstructive bronchitis in children aged less than two years

Abstract

In a prospective study 101 children aged less than 2 years (median age 10 months), were examined the first time they were admitted to a paediatric ward for asthmatic symptoms. Two-thirds were boys and 58 had parents or siblings with allergic symptoms. During winter-spring, respiratory syncytial (RS) virus was verified in 50% of children. Other viral agents were adenovirus, parainfluenza 3, coxsackie B 2, ECHO 6 and rotavirus. At the acute stage, 54% of the children displayed changes on pulmonary X-ray. The total IgE value was greater than or equal to +2 SD score units in 14 children. At reinvestigation after 3-4.5 years, when the children were aged 3.3-6.3 years, 53% were free from asthmatic symptoms; the median age for the last episode was 2 years. A total of 33% had mild asthma, 8% moderate and 6% severe asthma. The factors which correlated significantly with persistent asthma were: (1) The need for daily medication for at least 6 months. (2) A young age in conjunction with the first wheezing episode and on the first admission to a paediatric ward because of asthmatic symptoms. (3) Other past or present atopic symptoms. Heredity, tobacco smoking at home, having a furry pet, RS virus infection, or high total IgE at the time of the first admission did not correlate significantly with the persistence of asthma 3-4.5 years later. The results emphasize the good overall prognosis of wheezing in early childhood, even when the wheezing is severe enough to lead to inpatient treatment.

Factors relating to the severity of symptoms at 5 yrs in children with severe wheeze in the first 2 yrs of life

“…For the group as a whole, Rrs6 was significantly lower in girls than boys (mean (SD), 94 (20) and 109 (22) % predicted, respectively; p=0.03) but there was no significant difference in the level of bronchial responsiveness between girls and boys (log PC15 (SD) 0.90 (0.47) and 0.99 (0.6), respectively; p=0.6).…”

“…It is of interest that, as in the study of WENNERGREN et al [20] who also measured total and specific IgE the only index of atopy to relate to symptoms in these 5 year old children was a personal history, the least objective measure and, therefore, the most open to bias. We calculated from the results of this study, that for a relationship between skin-prick test positivity (the most frequently used marker of atopy) and symptoms to become apparent with 80% power at the 5% level, a sample of more than 250 children including more than 200 symptomatic children would be needed.…”

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

“…Ongoing birth cohort studies should be able to provide information on the outcome in general populations during the 2010s. Considering more severe early wheeze, half of the children hospitalised with acute wheeze before the age of 2 yrs were symptom-free by the age of 5 yrs and 70% by 10 yrs, but only 57% by 17-20 yrs [44][45][46], illustrating the tendency for relapse during adolescence. Female sex, passive smoking during infancy and early sensitisation to allergens were risk factors for symptoms continuing into early adulthood, but type of virus and premature birth were not.…”

Mortality in Asthma-Chronic Obstructive Pulmonary Disease Overlap in the United States

“…The child's height should be measured every year, or more often. Asthma-like symptoms remit in a substantial proportion of children of 5 years or younger, [467][468][469] so the need for continued controller treatment should be regularly assessed (e.g. every 3-6 months) (Evidence D).…”