Preschool wheezing and prognosis at 10.

Abstract

SUMMARY Information was collected at birth and at 5 and 10 years of age on the national cohort of children born in one week of April 1970 (the Child Health and Education Study). For 11 465 children, information on wheezing attacks before 5 years was compared with reports of wheezing occurring in the 12 months before the interview at 10 years.Of 2345 children who had had at least one wheezing attack before their fifth birthday, 80% (1869) were free of wheeze at 10 years; only 8% of children who had just one wheezing attack by 5 years wheezed in their 10th year. The more attacks the child had had by the age of 5 the higher the risk of continuing to wheeze at the age of 10, but there were no major differences in prognosis according to the age of the first attack. Half of the children who had been labelled asthmatic at the age of 5 were wheezing at the age of 10 compared with an eighth of those with wheezing not so labelled. There was little evidence to suggest that the prognosis of wheezing with bronchitis was markedly different from that of children with other episodes of wheezing provided they were not said to be asthmatic. A longer follow up is necessary to ascertain whether remission at the age of 10 is followed by relapse later.Asthma in childhood is one of the commonest disorders to cause both acute and prolonged morbidity. Children labelled asthmatic constitute only a proportion of those with wheezing attacks. Data from the 1970 British National Cohort Study indicated that by the age of 5 years 21% of all children had had at least one episode of wheezing on the chest and by 10 years 27% had had such a history.'For the parents to understand the condition and for the physician to assess the value of his treatment,2 knowledge of the natural history of childhood asthma is essential.Blair followed two groups of asthmatic children prospectively for over 20 years, by which time 52% of both groups had stopped wheezing.3 The final prognosis was influenced by the severity of the asthma at onset but not by the age at onset or the results of skin tests. Other series disagree and imply that age of onset is the best determinant of severity.4The present paper addresses the problem of predicting whether children who wheeze in the first five years of life will still be wheezing at the age of 10.

Prognosis of wheezing and asthma presenting in early childhood

“…The Tuscon cohort also demonstrated similar associations, in that children with persistent wheezing were more likely to have wheezed often or very often when compared to those with transient wheeze [6]. Similar observations have been made in the Avon cohort, in that the more frequent attacks children had in infancy, the less likely they were to be symptom-free at 10 years [41]. Similar features have been reported for persistence into adulthood [12,15,19,60], and the oldest reported long-term follow-up study also concluded that severe childhood asthma predisposed to chronic persistent adult disease [34].…”

“…The Avon (UK) birth cohort has also shown that, at 9 years, children whose first attack was in infancy had a better prognosis than those with onset in the 2nd year of life [41]. In pre-school children and after adjustment for the effect of sex, the cumulative prevalence of doctor-diagnosed asthma increases with age of presentation, the estimated multiplicative increase being 1.27 (1.12 to 1.45) for each additional year of age [29].…”

Bronchoalveolar lavage findings suggest two different forms of childhood asthma

“…The serum concetitratioti of IgE is sigtiificatitly elevated in most patients with allergic diseases such as extrinsic asthma, hay fever and atopic diseases. It is well known that many young children with the clinical pattern of viral associated wheeze will soon outgrow their symptoms, whereas a smaller number go on to develop more classical atopic asthma [15,16]. The differences in eosinophil numbers we found between AA and YAW are unlikely to be due to the For comparative purposes the data from children with viral associated wheeze has also been included.…”

Prospective study of risk factors for early and persistent wheezing in childhood

“…Furthermore, whilst wheezing in infancy is common, it appears to have a favourable prognosis, since the majority of children who wheeze in early childhood are free of symptoms by adolescence or early adulthood [9,[23][24][25]. At present, it is not understood why wheezing illness persists in some children, when in most it resolves spontaneously.…”