PURPOSE OF THE STUDY.
To assess the prognosis of early-life recurrent bronchial obstruction (rBO) through adolescence.
Five hundred and fifty of the 3754 healthy newborns enrolled in the Environment and Childhood Asthma prospective population-based birth cohort study in Oslo, Norway, and attended the 16-year follow-up study visit.
rBO was determined between 0 and 2 years of age as ≥2 episodes of ≥3 respiratory symptoms (tachypnoea, wheezing, expiratory stridor, respiratory chest retractions, and sibilations/whistles) or if such an episode lasted ≥4 weeks. Subjects were assessed again at age 10 and 16 years of age for diagnosis of asthma, bronchial hyperresponsiveness (BHR) by methacholine challenge, and asthma symptoms (heavy breathing, wheezing, chest tightness, or dry nighttime cough without current cold or lower airway infection). Asthma was defined as ≥2 of the following: doctor-diagnosed asthma, asthma symptoms, and the use of antiasthmatic medication.
Of the 143 subjects with rBO at 2 years of age, 71% were classified as asthma between 2 and 10 years and 34% between 10 and 16 years of age, including 10% of those who were in remission in the 2- to 10-year time period and relapsed in adolescence. Forty-eight percent of the adolescents in the rBO–remission group had ≥1 of the reported asthma symptoms, asthma medication use, or BHR compared with 26.7% of those with no rBO/never asthma (P = .001). Lung function was significantly reduced in the rBO–remission group and rBO–asthma group compared with the no rBO group and similar to each other.
The prognosis of early rBO in this cohort demonstrated that only one-third had persistent asthma throughout childhood and adolescence. However, those with rBO at age 2 in remission at age 16 had reduced lung function as well as more frequent BHR and use of asthma medications, possibly indicating increased risk of subsequent respiratory disease in adulthood.
This study reaffirms the overall good prognosis for infants and toddlers with a recurrent wheezy phenotype. However, half of the children with rBO and subsequent remission still suffered from asthma symptoms, used asthma medications, or had BHR in adolescence, indicating that the prevalence of asthma may be an underestimate of subsequent respiratory morbidity associated with early-life rBO.
- Copyright © 2013 by the American Academy of Pediatrics