Incidence Of Wheeze Research Articles

Probiotic supplementation during pregnancy or infancy for the prevention of asthma and wheeze: systematic review and meta-analysis

Objective To evaluate the association of probiotic supplementation during pregnancy or infancy with childhood asthma and wheeze.Design Systematic review and meta-analysis of randomised controlled trials.Data sources Medline, Embase, and Central...

Early patterns of wheezing in asthmatic and nonasthmatic children

The aim of this study was to describe the time patterns of wheezing in both asthmatic and nonasthmatic children during the first 36 months of life, and to determine whether there are asthma-related breakpoints in the incidence of wheezing. Data from a historical cohort of children followed from birth to 6 years (SLAM cohort) were used. Wheezing episodes until 36 months and asthma at 6 years were both recorded by a doctor. Monthly mean incidence rate of wheezing and rate ratio were calculated. Joinpoint regression models were built to identify breakpoints in the risk of wheeze. Complete information was available for 3739 children. Wheezing in the first 36 months was more frequent in asthmatic than in nonasthmatic children (rate ratio 2.62, 95% CI 1.81-3.78). Differences were appreciable within the first months and increased steadily thereafter because of a persistently high rate in asthmatic children. No breakpoint in the rate ratio could be identified. Asthmatic children exhibited a one-phase curve of incidence and nonasthmatic children exhibited a two-phase curve. However, children with allergic asthma also displayed a two-phase curve. There is no identifiable breakpoint during the first 36 months of life at which the incidence of wheezing in asthmatic children begins to stand out.

Is Obesity a Risk Factor for Wheezing Among Adolescents? A Prospective Study in Southern Brazil

PurposeTo investigate the effect of obesity at the start of adolescence on the prevalence, incidence and maintenance of chest wheezing among individuals aged 11–15 years in a birth cohort in a developing country.MethodsThe seventh follow-up of the 1993 Pelotas birth cohort occurred in 2004 (individuals aged 10–11 years). Between January and August 2008, the eighth follow-up of the cohort was conducted. All the individuals of the original cohort who were alive (who were then adolescents aged between 14 and 15 years) were targets for the study. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to define wheezing. In addition to the body mass index (BMI), used to define obesity by the World Health Organization (WHO) criteria, we assessed skinfold thickness.ResultsFrom the original cohort, 4,349 individuals were located (85.7% follow-up rate). The prevalence of chest wheezing at 11 and 15 years were 13.5% (95% CI: 12.5%–14.5%) and 12.1% (95% CI: 11.1%–13.1%), respectively. The prevalence of wheezing at both times was 4.5% (95% CI: 3.9%–5.1%) and the incidence of wheezing was 7.5% (95% CI: 6.7%–8.3%). Independent of the effect of various confounding variables, the prevalence of wheezing at 15 years was 50% greater among obese individuals than among eutrophic individuals at 11 years (RR 1.53; 95% CI: 1.14–2.05). The greater the skinfold tertile at 11 years, the higher the prevalence of wheezing at 15 years was (p = .011). Weight status and skinfolds did not present any association with incident wheezing. After controlling for confounding factors, the risk of persistent wheezing among obese individuals at 11 years was 1.82 (95% CI: 1.30–2.54).ConclusionsSince obesity at the start of adolescence is associated with asthma symptom persistence, prevention and treatment of obesity may reduce avoidable healthcare costs and disease burden.

Prenatal and Passive Smoke Exposure and Incidence of Asthma and Wheeze: Systematic Review and Meta-analysis

Exposure to passive smoke is a common and avoidable risk factor for wheeze and asthma in children. Substantial growth in the prospective cohort study evidence base provides an opportunity to generate new and more detailed estimates of the magnitude of the effect. A systematic review and meta-analysis was conducted to provide estimates of the prospective effect of smoking by parents or household members on the risk of wheeze and asthma at different stages of childhood. We systematically searched Medline, Embase, and conference abstracts to identify cohort studies of the incidence of asthma or wheeze in relation to exposure to prenatal or postnatal maternal, paternal, or household smoking in subjects aged up to 18 years old. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by using random effects model. We identified 79 prospective studies. Exposure to pre- or postnatal passive smoke exposure was associated with a 30% to 70% increased risk of incident wheezing (strongest effect from postnatal maternal smoking on wheeze in children aged ≤2 years, OR = 1.70, 95% CI = 1.24-2.35, 4 studies) and a 21% to 85% increase in incident asthma (strongest effect from prenatal maternal smoking on asthma in children aged ≤2 years, OR = 1.85, 95% CI = 1.35-2.53, 5 studies). Building upon previous findings, exposure to passive smoking increases the incidence of wheeze and asthma in children and young people by at least 20%. Preventing parental smoking is crucially important to the prevention of asthma.

Allergic Rhinitis as a Predictor for Wheezing Onset in School-aged Children

MK Rochat, S Illi, MJ Ege; Multicentre Allergy Study (MAS) Group. J Allergy Clin Immunol. 2010;126(6):1170–1175 To determine if rhinitis in early childhood is an independent predictor of wheezing between the ages of 5 and 13 years. The study followed 1314 healthy children, from birth to the age of 13 years, as part of the German Multicenter Allergy Study. This was a prospective, multicenter birth-cohort study that used standardized questionnaires, interviews, and objective sensitization methods. To better characterize the association between sensitization and rhinitis on the incidence of wheeze, 4 rhinitis phenotypes were …

Lactobacillus rhamnosus HN001 Attenuates Allergy Development in a Pig Model

BackgroundProbiotics have been studied as immunomodulatory agents of allergy. Several human probiotic trials tracking the development of eczema and other forms of allergy have yielded inconsistent results. A recent infant study demonstrated that pre and postnatal Lactobacillus rhamnosus HN001 (HN001) supplementation decreased the prevalence of eczema and IgE associated eczema. However, the influence of HN001 on the incidence of wheeze, asthma, and/or other allergic manifestations has yet to be reported.ObjectiveThis study was conducted to determine the effects of the probiotic HN001 on the development of allergic lung disease in a pig model.MethodsAllergy was induced by a series of subcutaneous and intratracheal sensitizations with Ascaris suum allergen (ASA) during a six week time frame in post-weanling pigs supplemented daily with HN001, or without supplementation. One week following final sensitization intradermal skin tests and respiratory challenges were conducted.ResultsIn response to intradermal and respiratory challenges, ASA-sensitized pigs fed HN001 had less severe skin flare reactions, smaller increases in pleural pressure, and trends towards lower changes in arterial oxygen and carbon dioxide partial pressure levels compared to control pigs. The frequency of ASA-specific IFN-γ-secreting peripheral blood mononuclear cells, as well as the amount of IL-10 produced by ASA-specific cells, was of greater magnitude in probiotic-fed pigs compared to control animals. These observations suggest that differences in clinical responses to the allergen challenges may be related to probiotic-induced modulation of Th1 (IFN-γ) and regulatory (IL-10) cytokine expression.ConclusionsProbiotic supplementation decreased the severity of allergic skin and lung responses in allergen-sensitized pigs with a corresponding increase in IFN-γ expression. A similar correlation between certain allergic responses and increased IFN-γ expression has been reported in human clinical studies of allergy; this pig model of allergy may be indicative of potential probiotic modulation of allergic lung disease in humans.

Associations between Traffic-related Exposures and Incidence of Wheeze among Children Age 5-7 in NYC

Associations between Traffic-related Exposures and Incidence of Wheeze among Children Age 5-7 in NYC

S112 The natural history of wheeze from birth to adult life: a cohort study

<h3>Introduction and objectives</h3> Wheeze is a common symptom at all ages. Its natural history from birth to adulthood was studied in a birth cohort of individuals at high risk of atopic illness. The objective was to ascertain factors associated with wheeze at different ages, distinguishing between wheeze that occurred at successive time points (persistent wheeze) and wheeze newly occurring (incident wheeze). <h3>Methods</h3> 497 infants were selected antenatally as having a first-degree relative with a history of asthma, hay fever or eczema. During their first year and at 7 years the children were examined, symptoms were recorded, skin prick tests performed and serum IgE measured. At 15 and 23 years further questionnaires were completed and (at 23) blood and skin tests performed. <h3>Results</h3> Information was obtained on 483 individuals at 1 year, 453 at seven, 363 at 15 and 304 at 23. The prevalence of wheeze was fairly constant over time (around 30%), remission being balanced by incidence over each interval. Wheeze at 1 year predicted wheeze at ages seven and 15, and at seven it predicted wheeze at 15 and 23, but it was associated with different factors at different times and according to whether it was persistent or incident. In infancy it was related to non-atopic factors such as infection, maternal smoking and breastfeeding (protective). Persistent wheeze to age 15 was related to respiratory infections in infancy and to atopy. Incident wheeze from one to 7 years was strongly associated with atopy, while late-onset wheeze was related to rhino conjunctivitis, smoking and (marginally) body mass. <h3>Conclusions</h3> Advances in the understanding and prevention of wheeze may be assisted by directing attention to maternal smoking, breastfeeding and respiratory infections in infancy, atopy in childhood, rhino conjunctivitis in adolescence, and smoking and perhaps obesity in adult life.

The role of acetaminophen and geohelminth infection on the incidence of wheeze and eczema: a longitudinal birth-cohort study.

Acetaminophen has been hypothesized to increase the risk of asthma and allergic disease, and geohelminth infection to reduce the risk, but evidence from longitudinal cohort studies is lacking. To investigate the independent effects of these exposures on the incidence of wheeze and eczema in a birth cohort. In 2005-2006 a population-based cohort of 1,065 pregnant women from Butajira, Ethiopia, was established, to whom 1,006 live singleton babies were born. At ages 1 and 3, questionnaire data were collected on wheeze, eczema, child's use of acetaminophen, and various potential confounders, along with a stool sample for geohelminth analysis. Those without wheeze (n = 756) or eczema (n = 780) at age 1 were analyzed to determine the independent effects of geohelminth infection and acetaminophen use in the first year of life on the incidence of wheeze and eczema by age 3. Wheeze and eczema incidence between the ages of 1 and 3 were reported in 7.7% (58 of 756) and 7.3% (57 of 780) of children, respectively. Acetaminophen use was significantly associated with a dose-dependent increased risk of incident wheeze (adjusted odds ratio = 1.88 and 95% confidence interval 1.03-3.44 for one to three tablets and 7.25 and 2.02-25.95 for ≥ 4 tablets in the past month at age 1 vs. never), but not eczema. Geohelminth infection was insufficiently prevalent (<4%) to compute estimates of effect. These findings suggest frequent acetaminophen use early in life increases the risk of new-onset wheeze, whereas the role of geohelminth infection on allergic disease incidence remains to be seen as the cohort matures.

Association of nutrient intake and wheeze or asthma in a Greek pre‐school population

The rise of asthma prevalence in children observed the last years might be related to several dietary factors/components as suggested by several researchers. We aimed to evaluate the potential relationship between certain nutrients intake and asthma occurrence in a population of pre-school children. In the framework of the cross-sectional study 'Growth, Exercise and Nutrition Epidemiological Study In pre-schoolers', data were collected from 1964 children, aged 24-72 months, living in five different counties in Greece. The International Study of Asthma and Allergies in Childhood questionnaire was used to assess asthma related outcomes. Dietary intake was assessed with 3 days diet records. The prevalence of ever wheeze, current wheeze and diagnosed asthma was 37.7%, 27.5% and 10.5% respectively. Dietary intake of magnesium had a 0.5% and 0.6% increase in the reported risk of current wheeze and diagnosed asthma respectively. On the contrary a decrease in the prevalence of ever (OR: 0.997, 95% CI: 0.995-1.000) and current wheeze (OR: 0.996, 95% CI: 0.993-0.999) was associated with vitamin C intake. Calcium intake slightly decreased the risk of current wheeze (OR: 0.999, 95% CI: 0.998-0.999). An increase of 2% of the risk of reporting ever or current wheeze was associated with mono-unsaturated fatty acid intake. Magnesium intake was the only independent predictor for doctor's diagnosed asthma. We conclude that dietary intake of vitamin C and calcium seem to have a protective effect on the incidence of wheeze in pre-school children, whereas magnesium and mono-unsaturated fatty acid may have a harmful role.

Increased Fraction of Exhaled Nitric Oxide Predicts New-Onset Wheeze in a General Population

Fraction of exhaled nitric oxide (Fe(NO)) is regarded as a marker of airway inflammation. It is unknown whether increased Fe(NO) in respiratorily healthy subjects increases the risk of developing wheeze. To examine if increased levels of Fe(NO) predicts later onset of wheeze. We followed up 2,200 men and women from a general population-based study. At baseline, the subjects were investigated with questionnaires, blood samples, pulmonary function tests, and Fe(NO). At follow-up 4 years later, all subjects were mailed a respiratory questionnaire. The association between incident wheeze and baseline levels of Fe(NO) over the 90th percentile were evaluated calculating hazard ratios using Cox regression models adjusted for smoking habits, age, height, sex, and atopy. The follow-up questionnaire was completed by 1,896 subjects (86.2%). All subjects reporting wheeze, asthma, or asthma symptoms at baseline were excluded resulting in a study population of 1,506 subjects. Of these, 49 subjects reported new-onset wheeze. The median concentration of Fe(NO) at baseline was significantly higher among those with new-onset wheeze (18.8 ppb vs. 15.8 ppb, P = 0.03). In a Cox regression model including all subjects, Fe(NO) over the 90th percentile predicted onset of wheeze (hazard ratio 2.7; 95% confidence interval, 1.4-5.4). In stratified models, this was most apparent among never-smokers and in atopic subjects, for whom the odds ratios were higher. Our results indicate that increased Fe(NO) is associated with an increased risk of developing wheeze. The results also support the hypothesis that increased level of Fe(NO) among subjects without respiratory symptoms is a sign of subclinical airways inflammation.

Effects of pets on asthma development up to 8 years of age: the PIAMA study

Recall bias may provide discrepant relationships of pet exposure with sensitization and asthma development. We studied prospectively effects of pets at home on development of sensitization, asthma and respiratory symptoms from birth up to age 8 years. Event history analysis was performed on annually registered data of 2951 children, participating in the PIAMA birth cohort study. Children with a cat or dog at home at 3 months of age had a significantly lower prevalence of sensitization to inhalant allergens at age 8, but not of asthma. A cat decreased the risk of house dust mite sensitization at age 8 [odds ratio (OR) = 0.68, 95% confidence interval (CI) 0.49-0.95], a dog of pollen sensitization (OR = 0.49, 95% CI: 0.29-0.83). A cat or dog at home did not significantly affect asthma incidence in each subsequent year. From 2 years of age onwards, the incidence of wheeze (OR = 1.52, 95% CI: 1.12-2.05) and a dry cough at night (OR = 1.28, 95% CI: 1.05-1.57) was higher in children with a dog, whereas removal of a dog increased the risk of developing asthma symptoms. Comparing analyses using prospectively and retrospectively collected data on diagnosed asthma showed important recall bias. Our prospective study shows a protective effect of early presence of pets at home on sensitization to inhalant allergens, but no prevention of asthma development. Furthermore, children with pets had more frequent transient or intermittent asthma symptoms. Parental report of asthma by recall may provide spurious results of these associations.

Insulin resistance as a predictor of incident asthma‐like symptoms in adults

There is accumulating evidence that obesity is associated with an increased risk of asthma. It has been hypothesized that insulin resistance may be involved in obesity-induced asthma, but till date there is no prospective data on this issue. To investigate the association of obesity and insulin resistance with the incidence of asthma-like symptoms in adults. Out of a random sample of 12 934 persons from a general population, 6784 (52.5%) were included and participated in a health examination in 1999-2001. After 5 years they were re-invited and 4516 (66.6%) participated at follow-up. At baseline three obesity measures were considered: body mass index, waist circumference, and waist-to-hip ratio. In addition, fasting glucose and insulin were measured for determination of insulin resistance. Information on asthma-like symptoms at baseline and follow-up were obtained by questionnaires. A total of 3441 participants defined as non-asthmatic at baseline and with complete information on all the considered variables were included in the analyses. Data were controlled for confounding by sex, age, social status, and smoking. All obesity measures were associated with incident wheezing and asthma-like symptoms. In addition, insulin resistance was associated with incident wheezing [odds ratio (OR) 1.87, 95% confidence interval (CI) 1.38-2.54] and asthma-like symptoms (OR 1.61, 95% CI 1.23-2.10). The effect of insulin resistance was stronger than that of obesity and was independent of sex. We found that insulin resistance was associated with an increased risk of developing asthma-like symptoms. This finding supports the hypothesis that obesity and asthma may be linked through inflammatory pathways also involved in insulin resistance.

Routine Vaccination Against Pertussis and the Risk of Childhood Asthma: A Population-Based Cohort Study

In industrialized countries vaccination coverage remains suboptimal, partly because of perception of an increased risk of asthma. Epidemiologic studies of the association between childhood vaccinations and asthma have provided conflicting results, possibly for methodologic reasons such as unreliable vaccination data, biased reporting, and reverse causation. A recent review stressed the need for additional, adequately controlled large-scale studies. Our goal was to determine if routine childhood vaccination against pertussis was associated with subsequent development of childhood wheezing disorders and asthma in a large population-based cohort study. In 6811 children from the general population born between 1993 and 1997 in Leicestershire, United Kingdom, respiratory symptom data from repeated questionnaire surveys up to 2003 were linked to independently collected vaccination data from the National Health Service database. We compared incident wheeze and asthma between children of different vaccination status (complete, partial, and no vaccination against pertussis) by computing hazard ratios. Analyses were based on 6048 children, 23 201 person-years of follow-up, and 2426 cases of new-onset wheeze. There was no evidence for an increased risk of wheeze or asthma in children vaccinated against pertussis compared with nonvaccinated children. Adjusted hazard ratios comparing fully and partially vaccinated with nonvaccinated children were close to one for both incident wheeze and asthma. This study provides no evidence of an association between vaccination against pertussis in infancy and an increased risk of later wheeze or asthma and does not support claims that vaccination against pertussis might significantly increase the risk of childhood asthma.

Magnesium level in chronic asthmatic children &amp;ndash; effect of corticosteroid treatment

Hypomagnesaemia is suggested to be associated with increased incidence of wheeze, airway hyperreactivity and impairment of lung functions. We aimed to assess the serum magnesium level in asthmatic children and evaluate the effect of corticosteroid treatment on it. The study included 89 chronic asthmatic children aged 5-15 years receiving inhaled fluticasone propionate and short courses of oral methyl prednisolone during exacerbation. About 12 of them stopped steroid treatment three months before inclusion in the study. About 27 healthy children served as controls. Serum magnesium was significantly lower in asthmatics receiving steroid compared to controls and to those not receiving steroid. No significant difference was found between asthmatics not receiving steroid and controls. A significant negative correlation was found between serum magnesium and frequency of oral corticosteroid. Thus, use of corticosteroid in asthmatics reduces magnesium level with recovery to normal after steroid cessation. Magnesium supplementation is recommended to those receiving steroid.

Maternal Smoking and Environmental Tobacco Smoke Exposure and the Risk of Allergic Diseases in Japanese Infants: The Osaka Maternal and Child Health Study

Purpose. It remains controversial whether environmental tobacco smoke increases the risk of allergic diseases. The present prospective cohort study examined whether in utero exposure to maternal smoking and postnatal exposure to environmental tobacco smoke were associated with the development of wheeze, asthma, and atopic eczema in Japanese infants. Methods. Study subjects included 763 infants. Data were obtained through the use of questionnaires completed by the mother during pregnancy and at 2 to 9 and 16 to 24 months postdelivery. Information regarding maternal smoking during pregnancy and postnatal exposure to environmental tobacco smoke was collected at 2 to 9 months postdelivery, and information on allergic symptoms was collected when the infant was between 16 to 24 months of age. Cases were defined according to criteria of the International Study of Asthma and Allergies in Childhood for wheeze and atopic eczema. Additionally, doctor-diagnosed asthma and atopic eczema were identified. Adjustment was made for maternal age, family income, maternal and paternal education, parental history of asthma, atopic eczema, allergic rhinitis, indoor domestic pets, baby's older siblings, baby's sex, birth weight, and time of surveys. Results. The cumulative incidence of wheeze, atopic eczema, doctor-diagnosed asthma, and doctor-diagnosed atopic eczema was 22.1%, 18.6%, 4.3%, and 9.0%, respectively. Maternal smoking during pregnancy was not related to the risk of wheeze, whereas postnatal maternal smoking in the same room as the child increased the risk of wheeze. No significant association was observed between perinatal tobacco smoke exposure and the development of asthma and atopic eczema. Conclusions. Our findings suggest that postnatal maternal smoking might be associated with an increased risk of wheeze in Japanese infants.

Does traffic-related air pollution contribute to respiratory disease formation in children?

In the current issue of the European Respiratory Journal , Brauer et al. 1 report positive associations between markers of traffic-related air pollution and respiratory health outcomes, including asthma onset, incidence of wheeze, ear/nose/throat infections and serious colds or flu, in a large cohort of children 4 yrs of age. This study replicates and extends earlier findings on the same birth cohort at 2 yrs of age. Although a replication, the findings here are more compelling than the earlier study for a number of reasons. First, the effects are larger and more consistent than in the study of the children at 2 yrs of age. In the field of air pollution epidemiology, which closely links to government policy and regulation, concepts such as statistical significance take on a greater meaning, one that often goes beyond what epidemiologists and health scientists consider essential to interpreting results. The stronger and more consistent effects in the current study bolster a growing body of research suggesting that more refined exposure metrics associate with larger respiratory health effects in children, which are discussed hereafter. Secondly, and linked to the first point, the diagnostic accuracy of the conditions after the first 4 yrs of life is likely to be higher than in the first 2 yrs of life, again leading to greater confidence in the association. The relative consistency of the associations at 4 yrs of age compared with those at 2 yrs of age suggests that onset and persistence of respiratory disease formation begins at an early age and continues throughout the course …

Atopische Erkrankungen im Kindes- und Jugendalter: Häufigkeiten und Trends weltweit. Eine Literaturauswahl zur Internationalen Studie zu Asthma und Allergien bei Kindern (ISAAC)

Introduction: Asthma and allergies are the most important chronic diseases in childhood. During the 90es, a future increase in prevalence rates was assumed. Methods: To measure the prevalence of asthma and allergy the ISAAC-Study was performed worldwide in 3 phases in about 50 countries including more than 1 million children. Standardised questionnaires asking for diseases and risk factors as well as objective measurements in Phase II were applied. Results: The prevalence of wheeze in 6- to 7-year-old children ranged in from 4.1 - 32.1% in 1994/1995. The frequency of hay fever varied from 0.8 -14.9%, and that of flexural eczema from 1.1 -18.4%. The prevalence of wheeze in 13- to 14-year-old children ranged from 2.1 -32.2%. According to the results of Phase II the fraction of wheeze attributable to atopic sensitisation and the gross national income were strongly correlated (p = 0.74, p < 0.001). Overall, there was a heterogeneous pattern regarding increase and decrease of disease prevalence assessed in Phase Three in 2002/2003. In Munster (Germany) an increase in prevalence rates of all 3 diseases of up to 0.7% points per year could be observed. In a follow-up of the German Phase II children in the age of 16 - 18 years the incidence of wheeze was 13%, of hay fever 27%, and of flexural eczema 6%. Conclusion: The prevalence of asthma, atopic asthma and allergic diseases varied strongly worldwide. Despite a heterogeneous pattern an increase of disease was more often recorded. Even in adolescent a relevant incidence rate of wheeze must be assumed.

2 The Role of puberty and other risk factors for incident wheeze

2 The Role of puberty and other risk factors for incident wheeze

The “Atopic March”: MAS study

Only longitudinal studies are able to dissect risk factors associated either with the new onset of a disease or with the severity of an illness. Furthermore, the timing of any relevant exposure prior to the onset of symptoms is difficult to assess in cross-sectional studies, considering the retrospective nature of the exposure assessment. Due to these inherent limitations of these types of studies, a number of prospective surveys such as the German Multicenter Birth cohort, the MAS Study have been carried out which have considerably advanced our understanding of the natural history of allergic sensitization and its relation to asthma. Whereas, house dust mite and cat allergen exposure was a risk factor for the development of sensitization towards that specific allergen, the incidence of wheeze, asthma and airway hyperresponsiveness was not affected by the level of allergen exposure. In contrast, early life infections such as repeated rhinitis episodes in the first year of life were inversely related to the development of asthma.