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Asthma and lung function 20 years after wheezing in infancy: results from a prospective follow-up study.

Abstract

OBJECTIVE

To determine the outcome until adulthood after wheezing in infancy, compared with pneumonia in infancy and with controls.

DESIGN

An 18- to-20-year prospective cohort study.

SETTING

Pediatric department at a university hospital, providing primary hospital care for a defined population. Patients Fifty-four children hospitalized for bronchiolitis and 34 for pneumonia at younger than 2 years, and 45 controls with no early-life wheezing or hospitalization, were studied at median age 19 years.

MAIN OUTCOME MEASURES

A questionnaire on asthma symptoms and medication, physical examination, flow volume spirometry (FVS), methacholine inhalation challenge (MIC), home peak expiratory flow (PEF) monitoring, and skin prick testing (SPT) to common inhalant allergens. The 2 asthma definitions were physician-diagnosed asthma and previously diagnosed asthma with recent asthmatic symptoms (physician-diagnosed asthma included).

RESULTS

By the 2 definitions, asthma was present in 30% (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.12-10.10) and in 41% (OR 1.38; 95% CI, 0.37-5.21) in the bronchiolitis group, in 15% (OR, 5.50; 95% CI, 1.87-16.14) and in 24% (OR, 2.07; 95% CI, 0.59-7.22) in the pneumonia group, and in 11% in the control group. After bronchiolitis, the FVS values were forced vital capacity (FVC), 108% (SD, 13%) of predicted; forced expiratory volume in 1 second, 98% (SD, 12%); forced expiratory volume in 1 second divided by FVC, 91% (SD, 7.6%); midexpiratory flow at 50% of the FVC, 74% (SD, 19%); and midexpiratory flow at 25% of the FVC, 74% (SD, 22%). Bronchial reactivity by MIC was present in 25 (48%) of 52 subjects in the bronchiolitis group, in 13 (42%) of 31 in the pneumonia group, and in 14 (32%) of 44 in the control group. The prevalence of atopy (positive SPTs) was 48% to 63% in the 3 groups. In a logistic regression adjusted for atopy and smoking, infantile bronchiolitis was an independent risk factor for asthma by both definitions.

CONCLUSION

The increased risk for asthma persists until adulthood after bronchiolitis in infancy.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Pediatrics, Kuopio University Hospital, and Kuopio University, Kuopio, Finland.

    , , ,

    Source

    MeSH

    Adolescent
    Adult
    Asthma
    Bronchiolitis
    Case-Control Studies
    Child
    Child, Preschool
    Finland
    Follow-Up Studies
    Hospitalization
    Humans
    Hypersensitivity
    Infant
    Pneumonia
    Prospective Studies
    Respiratory Function Tests
    Respiratory Sounds
    Surveys and Questionnaires

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    15520345

    Citation

    Piippo-Savolainen, Eija, et al. "Asthma and Lung Function 20 Years After Wheezing in Infancy: Results From a Prospective Follow-up Study." Archives of Pediatrics & Adolescent Medicine, vol. 158, no. 11, 2004, pp. 1070-6.
    Piippo-Savolainen E, Remes S, Kannisto S, et al. Asthma and lung function 20 years after wheezing in infancy: results from a prospective follow-up study. Arch Pediatr Adolesc Med. 2004;158(11):1070-6.
    Piippo-Savolainen, E., Remes, S., Kannisto, S., Korhonen, K., & Korppi, M. (2004). Asthma and lung function 20 years after wheezing in infancy: results from a prospective follow-up study. Archives of Pediatrics & Adolescent Medicine, 158(11), pp. 1070-6.
    Piippo-Savolainen E, et al. Asthma and Lung Function 20 Years After Wheezing in Infancy: Results From a Prospective Follow-up Study. Arch Pediatr Adolesc Med. 2004;158(11):1070-6. PubMed PMID: 15520345.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Asthma and lung function 20 years after wheezing in infancy: results from a prospective follow-up study. AU - Piippo-Savolainen,Eija, AU - Remes,Sami, AU - Kannisto,Senja, AU - Korhonen,Kaj, AU - Korppi,Matti, PY - 2004/11/3/pubmed PY - 2004/12/16/medline PY - 2004/11/3/entrez SP - 1070 EP - 6 JF - Archives of pediatrics & adolescent medicine JO - Arch Pediatr Adolesc Med VL - 158 IS - 11 N2 - OBJECTIVE: To determine the outcome until adulthood after wheezing in infancy, compared with pneumonia in infancy and with controls. DESIGN: An 18- to-20-year prospective cohort study. SETTING: Pediatric department at a university hospital, providing primary hospital care for a defined population. Patients Fifty-four children hospitalized for bronchiolitis and 34 for pneumonia at younger than 2 years, and 45 controls with no early-life wheezing or hospitalization, were studied at median age 19 years. MAIN OUTCOME MEASURES: A questionnaire on asthma symptoms and medication, physical examination, flow volume spirometry (FVS), methacholine inhalation challenge (MIC), home peak expiratory flow (PEF) monitoring, and skin prick testing (SPT) to common inhalant allergens. The 2 asthma definitions were physician-diagnosed asthma and previously diagnosed asthma with recent asthmatic symptoms (physician-diagnosed asthma included). RESULTS: By the 2 definitions, asthma was present in 30% (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.12-10.10) and in 41% (OR 1.38; 95% CI, 0.37-5.21) in the bronchiolitis group, in 15% (OR, 5.50; 95% CI, 1.87-16.14) and in 24% (OR, 2.07; 95% CI, 0.59-7.22) in the pneumonia group, and in 11% in the control group. After bronchiolitis, the FVS values were forced vital capacity (FVC), 108% (SD, 13%) of predicted; forced expiratory volume in 1 second, 98% (SD, 12%); forced expiratory volume in 1 second divided by FVC, 91% (SD, 7.6%); midexpiratory flow at 50% of the FVC, 74% (SD, 19%); and midexpiratory flow at 25% of the FVC, 74% (SD, 22%). Bronchial reactivity by MIC was present in 25 (48%) of 52 subjects in the bronchiolitis group, in 13 (42%) of 31 in the pneumonia group, and in 14 (32%) of 44 in the control group. The prevalence of atopy (positive SPTs) was 48% to 63% in the 3 groups. In a logistic regression adjusted for atopy and smoking, infantile bronchiolitis was an independent risk factor for asthma by both definitions. CONCLUSION: The increased risk for asthma persists until adulthood after bronchiolitis in infancy. SN - 1072-4710 UR - https://www.unboundmedicine.com/medline/citation/15520345/Asthma_and_lung_function_20_years_after_wheezing_in_infancy:_results_from_a_prospective_follow_up_study_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/archpedi.158.11.1070 DB - PRIME DP - Unbound Medicine ER -