Background
While sexual dimorphism in wheeze and asthma prevalence are well documented, sex-specific risk factors for wheeze and longitudinal wheeze phenotypes have not been well elucidated.
Objective
Using a large pre-birth cohort, this study aimed to identify sex-specific risk factors for wheeze from birth through mid-childhood, and identify distinct longitudinal wheeze phenotypes and the sex-specific risk factors associated with these phenotypes.
Methods
Mothers reported child wheeze symptoms over the past year, approximately yearly on 9 occasions starting at age 1 year. We identified sex-specific predictors of wheeze, wheeze phenotypes, and sex-specific predictors of these phenotypes using generalized estimating equations, latent class mixed models, and multinomial logistic analysis, respectively.
Results
A total of 1623 children had information on wheeze at 1 or more time points. Paternal asthma was a stronger predictor of ever wheeze in boys (OR=2.15, 95% CI 1.74, 2.66) than in girls (OR=1.53, 95% CI 1.19, 1.96, p for sex by paternal asthma interaction=0.03), while being Black or Hispanic, birthweight for gestational age z-score, and breastfeeding duration have stronger associations among girls. We identified 3 longitudinal wheeze phenotypes: never/infrequent wheeze (74.1%), early transient wheeze (12.7%), and persistent wheeze (13.1%). Compared to never/infrequent wheeze, maternal asthma, infant bronchiolitis, and atopic dermatitis were associated with persistent wheeze in both sexes, but paternal asthma was associated with persistent wheeze in boys only (OR=4.27, 95% CI 2.33, 7.83, p for sex by paternal asthma interaction=0.02) while being Black or Hispanic was a predictor for girls only.
Conclusion
We identified sex-specific predictors of wheeze and longitudinal wheeze patterns, which may have important prognostic value and may allow for a more personalized approach to wheeze and asthma treatment.