Severity of obstructive airways disease by age 2 years predicts asthma at 10 years of age

Abstract

Background: Predicting school-age asthma from obstructive airways disease (OAD) in early life is difficult, even when parental and children's atopic manifestations are taken into consideration. Objective: To assess if the severity of OAD in the first 2 years of life predicts asthma at 10 years of age. Methods: From a nested case control study within the Environment and Childhood Asthma study, 233 2-year-old subjects with recurrent (>2 episodes) bronchial obstruction (rBO+) and 216 subjects without bronchial obstruction (rBO2) underwent clinical examination, parental interview, treadmill test and metacholine bronchial hyperresponsiveness (BHR) measurement at 10 years. A severity score at 2 years was calculated by frequency, persistence of bronchial obstruction and hospital admissions because of OAD. Main outcomes: Current asthma at 10 years (asthma with symptoms and/or asthma medication during the past year and/or positive treadmill test). Secondary outcome was metacholine BHR at 10 years. Results: Compared with rBO2 subjects, adjusted odds ratio (95% CI) of current asthma among rBO+ was 7.9 (4.1, 15.3), and among rBO+ with a severity score of .5, 20.2 (9.9, 41.3). In receiver operated characteristic analysis, positive and negative predictive values demonstrated the applicability and value of the score, with an optimal cut-off at severity score 5. Children with severity score .5 had severe BHR more often (PD 20 metacholine ,1 mmol) than children with a lower or 0 score (p = 0.0041). Conclusion: Using a simple scoring system, a high severity score of OAD by 2 years of age is a strong risk factor for, and may predict, current asthma at 10 years of age.

Global strategy for the diagnosis and management of asthma in children 5 years and younger

“…Children with asthma may To aid in the early identification, in the clinical setting, of children 5 years and younger who wheeze and are at high risk of developing persistent asthma symptoms, a number of risk profiles have been evaluated [53][54][55][56] . One such predictive assessment, the Asthma Predictive Index (API), is recommended for children with four or more wheezing episodes in a year and is based on information obtained from the Tucson (USA) Respiratory Study 54 .…”

Early-life wheeze: “the Child is father of the Man”

“…This is that a substantial proportion of early-life asthma or wheeze is associated with respiratory disease in adolescence or young adulthood. Our further findings suggest that a considerable proportion of RBO asthma in young adulthood is drawn from the early persistent wheeze phenotype, which is potentially identifiable at an early stage [4,9,10]. Such individuals appear to have more significant airway disease at 18 years of age.…”

Monitoring asthma in childhood

“…Recurrent wheeze in children <3 years of age is commonly associated with viral respiratory infection, whereas the prognosis of these children may be less favourable than previously reported as only one-third of children with recurrent bronchial obstruction in a birth cohort study were symptom free or medication free for asthma or BHR at 16 years of age [56][57][58][59][60][61]. However, several scores have been tested for their ability to predict persistence of asthma, such as the asthma predictive index and the Oslo severity score, with varying clinical value in individual patients [62,63].…”