PURPOSE OF THE STUDY.
The goal of this study was to evaluate whether categorizing children with early wheeze based on their trigger can help predict their disease course in the preschool years.
Initially, 300 children aged <3 years with a history of wheeze were enrolled. Follow-up data were available on 150 of the children at age 5 years.
The children with a history of wheeze were enrolled at <3 years of age and divided based on history into 3 groups: mild early viral wheeze (EVW), atopic multiple-trigger wheeze (MTW), and nonatopic uncontrolled wheeze. They were reassessed at 5 years of age and divided into 4 categories: asymptomatic, mild EVW, atopic MTW, and atopic uncontrolled wheeze. The evolution of clusters from infancy to school age was assessed by crossing the original phenotypes with the phenotypes obtained at 5 years of age.
Sixty-nine percent of children with mild EVW at 3 years of age were asymptomatic or continued to have mild EVW at age 5 years. The majority (59%) of children with nonatopic uncontrolled wheeze had the same severity at 5 years. The children with atopic MTW remained atopic at 5 years of age, and many of them developed uncontrolled wheeze (61%); none of the children in the atopic cluster developed the asymptomatic phenotype.
This study showed that disease progression in children with wheezing in early childhood depends largely on the expression of allergy. Children with viral wheezing had a good prognosis because most became asymptomatic or remained with mild EVW at age 5 years. On the contrary, none of the children with the atopic MTW phenotype became asymptomatic at 5 years. Many of the children who were initially in the nonatopic uncontrolled wheeze group had developed atopic uncontrolled wheeze by age 5 years.
There is an increasing appreciation for the fact that not all patients with asthma have the same disease. This prospective study supports the finding that early phenotypic identification is important and helpful. For the most part, children in each of the different phenotypes tend to maintain their “type” of asthma into preschool years. This information is a useful prognostic indicator. Furthermore, children with atopic disease tended to do more poorly over time. It is therefore imperative to establish whether a child with wheeze has environmental allergies early on because these children show great improvement in their asthma control with allergy immunotherapy, especially if started early.
- Copyright © 2014 by the American Academy of Pediatrics