Impact of childhood wheezing on lung function in adulthood: A meta-analysis

Ma, Huan; Li, Yuanyuan; Tang, Lin; Peng, Xin; Jiang, Lili; Jiao, Wan; Suo, Fengtao; Zhang, Guangli; Luo, Zhengxiu

doi:10.1371/journal.pone.0192390

Cited by 18 publications

(16 citation statements)

References 44 publications

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“…Prior work has suggested that early suppression of lung growth resulting in reduced maximum lung function in adulthood is associated with an increased risk of developing COPD 33–37. Childhood wheezing, childhood asthma, and childhood respiratory infections have been identified as factors associated with permanently lower lung function 33,35. While neither ICS nor LTRA therapy was associated with reduced odds of wheezing/asthma attacks over 1 year in this study, we cannot exclude the potential for long-term benefits of therapy on the trajectory of lung growth for some children, and hence a future reduction in the risk of adult conditions such as COPD.…”

Section: Discussionmentioning

confidence: 99%

Matched cohort study of therapeutic strategies to prevent preschool wheezing/asthma attacks

Grigg¹,

Nibber²,

Paton³

et al. 2018

JAA

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BackgroundAn inhaled corticosteroid (ICS) or leukotriene receptor antagonist (LTRA) may prevent wheezing/asthma attacks in preschoolers with recurrent wheeze when added to short-acting β-agonist (SABA).ObjectiveThe aim of this historical matched cohort study was to assess the effectiveness of these treatments for preventing wheezing/asthma attacks.MethodsElectronic medical records from the Optimum Patient Care Research Database were used to characterize a UK preschool population (1–5 years old) with two or more episodes of wheezing during 1 baseline year before first prescription (index date) of ICS or LTRA, or repeat prescription of SABA. Children initiating ICS or LTRA on the index date were matched 1:4 to those prescribed only SABA for age, sex, year of index prescription, mean baseline SABA dose, baseline attacks, baseline antibiotic prescriptions, and eczema diagnosis. Wheezing/asthma attacks (defined as asthma-related emergency attendance, hospital admission, or acute oral corticosteroid prescription) during 1 outcome year were compared using conditional logistic regression.ResultsMatched ICS and SABA cohorts included 990 and 3,960 children, respectively (61% male; mean [SD] age 3.2 [1.3] years), and matched LTRA and SABA cohorts included 259 and 1,036 children, respectively (65% male; mean [SD] age 2.6 [1.2] years). We observed no significant difference between matched cohorts in the odds of a wheezing/asthma attack: ICS vs SABA, OR (95% CI) 1.01 (0.85–1.19) and LTRA vs SABA, OR (95% CI) 1.28 (0.96–1.72).ConclusionWe found no evidence that initiation of ICS or LTRA therapy is associated with fewer attacks during 1 outcome year than SABA alone for a heterogeneous group of preschool children with recurrent wheeze in the real-life clinical setting.

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Section: Discussionmentioning

confidence: 99%

Matched cohort study of therapeutic strategies to prevent preschool wheezing/asthma attacks

Grigg¹,

Nibber²,

Paton³

et al. 2018

JAA

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“…Transient wheeze has, however, repeatedly been associated with diminished lung function early in life, at school age and into adulthood. 11,13,14 The progression of asthma over school age and adolescence is related to the early development of atopic sensitization.…”

Section: Lung Fun C Tion Deficits Among Children With a S Thma And mentioning

confidence: 99%

“…This temporal pattern has been termed “transient wheeze” and has been replicated in numerous other prospective studies using investigator‐ or data‐driven definitions by latent class analyses. Transient wheeze has, however, repeatedly been associated with diminished lung function early in life, at school age and into adulthood . The progression of asthma over school age and adolescence is related to the early development of atopic sensitization.…”

Section: Lung Function Deficits Among Children With Asthma and Wheezementioning

confidence: 99%

Addressing the risk domain in the long‐term management of pediatric asthma

Hamelmann

Bush

Szefler

2019

Pediatric Allergy Immunology

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There is growing concern regarding the long‐term outcomes of early and poorly controlled childhood asthma, either of which can potentially lead to the development of severe asthma in adults and irrecoverable loss of lung function leading to chronic obstructive pulmonary disease. These outcomes of inadequately controlled asthma should prompt a change in practice to better and/or earlier identify children at risk of adverse respiratory outcomes of asthma, to monitor disease progression, and to design intervention strategies that could either prevent or reverse asthma progression in children. The careful follow‐up of spirometry over time—in the form of lung function trajectories, the application of biomarkers to assist in the diagnosis of early asthma and medication selection for these patients, as well as methods to identify patients at risk of asthma attacks—can be used to develop individualized management strategies for children with asthma. It is now time for asthma specialists to communicate this information to patients, parents, and primary care physicians and to incorporate them into routine clinical assessments of children with asthma. In time, these concepts of risk management and prevention can be refined to provide a more comprehensive approach to asthma care so as to prevent adverse respiratory outcomes from poorly controlled childhood asthma.

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“…It has been described that adult asthmatics who have a reduced lung function have had this condition since at least the age of 9 years (4). A recent metanalysis showed that serious infant asthma may be accompanied by a reduction in lung function that persists into adult life (5). The challenge is to know if the altered lung function is a risk factor for asthma, as a consequence of congenital characteristics in the airways, or if asthmatic patients suffer from a loss in lung function as early as 9 years of age, or even before, as a consequence of an early remodeling of the airways.…”

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confidence: 99%

Early Lung Function and Future Asthma

Sánchez-Solís

2019

Front. Pediatr.

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Asthmatic adults with lower lung function have been described as having had this worse condition early in life. Lung function is reduced in children with persistent asthma and continues low throughout adult life. The challenge is to know if impaired lung function is a risk factor of asthma, as a consequence of special congenital characteristics of the airways, or whether asthmatic patients suffer a loss in lung function as early as 9 years of age as a consequence of very precocious remodeling of the airways. The loss is so early in life that it is probably a congenital characteristic, however there is not a cut-off point with clinical interest to predict risk of asthma later in life. There are contradictory results regarding whether asthmatic children lose lung function as a consequence of the airway remodeling by the illness itself. This aspect seemed to be shown for children at risk—the offspring of asthmatic mothers. The early BHR seems to be very frequent even in healthy infants, but is probably not a risk factor for asthma years later; except in the offspring of asthmatic mothers in which it has been shown. There are still many uncertainties in this field; so, more research is needed in order to better understand the pathophysiology of asthma, the early risk factors and to design new therapeutic targets and early interventions to change the natural history of the disease.

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Impact of childhood wheezing on lung function in adulthood: A meta-analysis

Cited by 18 publications

References 44 publications

Matched cohort study of therapeutic strategies to prevent preschool wheezing/asthma attacks

Matched cohort study of therapeutic strategies to prevent preschool wheezing/asthma attacks

Addressing the risk domain in the long‐term management of pediatric asthma

Early Lung Function and Future Asthma

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