Focus area: Physicians
Factors predicting future asthma in wheezing children
Wheezing is a worrying event for families and pediatricians, because it can herald the development of asthma. Up to 50% of children, indeed, experience at least one wheezing episode before the age of three, but recurrent wheeze in early childhood is not always asthma and about one-half of wheezing preschool children will outgrow their symptoms by school age. The clinical and pathological factors that could predict the future development of asthma in wheezing children have not been clearly identified, so it is still a matter of vivid debate.
The aim of the study of Bonato M at al was to assess the clinical characteristics (with particular focus in the presence and type of wheezing) and the airway pathological features present in early childhood that could herald the development of asthma later on in life. For this purpose, the authors evaluated clinically and pathologically a cohort of 80 children that were recruited at Woman’s and Child Health Department, University of Padova, Italy, from 2002 to 2014. The children, with a mean age of 3.8 years, undergoing a clinically indicated bronchoscopy were followed prospectively for a median of 5 yrs. At baseline clinical characteristics, focusing on wheezing and its presentation in episodic or multitrigger, were collected. Structural and inflammatory changes were quantified in bronchial biopsies. Follow-up data were available in 74 of the 80 children. Children with multitrigger wheeze were more likely to be asthmatics at follow-up than those with episodic (p=0.04) or without wheeze (p <0.0001). Children with asthma also had lower prevalence of breast-feeding (p=0.02), lower birthweight (p=0.02), and a trend for increased IgE (p=0.07) at baseline than those with no asthma. Basement membrane thickness and airway eosinophils at baseline were increased in children who developed asthma at follow-up (p=0.001 and p=0.026, respectively). Multivariate analysis showed that, among all clinical and pathological factors, multitrigger wheezing, basement membrane thickening and reduced birth weight were predictive of future asthma development.
This prospective study shows that multitrigger wheezing in early childhood and reduced birth weight are clinical predictors of asthma development. It also provides evidence that pathological abnormalities characteristic of asthma, like basement membrane thickening, are present in early childhood and predict future asthma, highlighting the importance of airway remodeling in early life as a risk for future development of asthma.
Ref.: Bonato M et al. Clinical and Pathologic Factors Predicting Future Asthma in Wheezing Children. A Longitudinal Study. Am J Respir Cell Mol Biol 2018 May 29. doi: 10.1165/rcmb.2018-0009OC.