Prognosis of wheezing and asthma presenting in early childhood

Abstract

Key pointsChildhood asthma and wheezing illness encompass a wide clinical spectrum.Most children with asthma first present before the age of 3 years.Coexistent atopy and initial disease severity carry a poor long-term prognosis.A switch from male to female predominance occurs at puberty.Good prognostic factors include presentation before 2 years of age and exclusively virally induced episodes.CME article: educational aimsTo identify the different types of wheezing illness in asthma that present in childhood.To aid healthcare professionals in the discussion of medium- to long-term prognosis with parents of children presenting with wheezing illness.To place prophylactic therapy in the context of the natural history of the disease.SummaryChildhood asthma covers a wide spectrum, ranging from mild-intermittent to severe-persistent disease, with different natural histories. Female sex, age at presentation, atopic constitution, parental atopy, and severity and frequency of attacks can all be identified as risk factors for persistence into adult life, while others, including maternal smoking, prematurity and bronchiolitis of infancy, do not appear to be associated to such an extent. The use of prognostic features alongside assessment of disease severity should inform long-term clinical management and be useful in counselling the child and her/his family.

Prescribing of asthma medication in primary care for children aged under 10

“…Based on cohort studies, a breaking point at 2 years of age is considered appropriate, with the majority of those presenting symptoms before this age becoming asymptomatic by mid-childhood. 22 Consistent with another Dutch study in primary care, 20 we found that less than 40% of all children with a first prescription of asthma medication had a registered doctor diagnosis of asthma. The incremental change in the likelihood of having a doctor diagnosis of asthma with each repeated prescription of asthma medication found in our study ( Figure 2) is also in line with the findings of Zuidgeest et al However, both studies reveal that, even in children with prolonged use of asthma medication (and in children older than 6 years of age), a large proportion of children receive asthma medication without having a doctor diagnosis of asthma.…”