PEDIATRICS Vol. 114 No. 2 August 2004, pp. 520
BREASTFEEDING AND THE PREVALENCE OF ASTHMA AND WHEEZE IN CHILDREN: ANALYSES FROM THE THIRD NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY, 1988–1994
Bridgette Jones, MD,
Stacie M. Jones, MD
Little Rock, AR
Chalada P, Arbes S, Dunson D, Zeldin DC. J Allergy Clin Immunol. 2003;111:328–336
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Purpose of the Study.
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To determine whether breastfeeding has an association with the
development of recurrent wheeze, asthma, or both among children
up to 72 months of age and whether the duration or exclusivity
of breastfeeding has an effect on this association.
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Study Population.
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Children (
n = 8261), 2 to 71 months of age, were sampled from
the Third National Health and Nutrition Examination Survey,
a nationally representative, cross-sectional survey conducted
between 1988 and 1994 and designed to provide health estimates
for the US population.
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Methods.
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Data used in this study were obtained with the Third National
Health and Nutrition Examination Survey Household Youth Questionnaire.
Data were tested for significant associations between breastfeeding
and physician-diagnosed asthma or recurrent wheeze (
3 episodes
of wheeze within the previous 12 months), with and without adjustments
for confounding variables.
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Results.
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Of the original cohort, 7766 children had available data on
breastfeeding duration, recurrent wheeze, and all covariates.
Prevalences of physician-diagnosed asthma and recurrent wheeze
were 5.9% and 7.6%, respectively. Approximately one-half of
the children were reported to have ever been breastfed. Unadjusted
model results showed that children who had ever been breastfed
were less likely to be diagnosed with asthma or to have recurrent
wheeze, compared with those who had never been breastfed, whereas
those were breastfed for a longer time (
4 months) had the lowest
odds of asthma or wheeze. After adjustment for potential confounders,
these results were not statistically significant. However, the
investigators showed that children who had ever been breastfed
had a decreased likelihood of recurrent wheeze or asthma before
the age of 24 months, compared with children who had never been
breastfed. Children with environmental tobacco smoke (ETS) exposure
(37.9%) had a higher prevalence of asthma than did those from
smoke-free homes. Children between the ages of 2 and 71 months
with ETS exposure who had ever been breastfed were less likely
to develop recurrent wheeze or asthma than were children who
had not been breastfed, especially if the duration was
4 months.
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Conclusions.
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Breastfeeding might delay the onset of or actively protect children
<24 months of age against asthma and recurrent wheeze and
might reduce the prevalence of asthma and wheeze among children
exposed to ETS.
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Reviewers’ Comments.
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Recurrent wheeze and asthma are leading reasons for hospitalization
and emergency department visits among children in the United
States. Appropriate asthma diagnosis and treatment is especially
difficult among children <24 months of age. In addition,
ETS exposure is prevalent among young asthmatic patients and
can compromise clinical outcomes. This study indicates that
breastfeeding may have important effects on asthma and may provide
protection from the ill effects of ETS. Broad-based public health
strategies are needed to better educate individuals about preventive
measures, such as breastfeeding and reduction of ETS exposure.
PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics
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Purpose of the Study.
Study Population.
