Recurrent Wheezing In Infants Research Articles

Serum bilirubin is associated with a reduced risk of subsequent recurrent wheezing following acute respiratory syncytial virus bronchiolitis.

Bilirubin is a potent antioxidant and anti-inflammatory molecule that has been shown to ameliorate airway inflammation. We aimed to study whether serum bilirubin is protective and can predict the development of subsequent recurrent wheezing in infants with severe respiratory syncytial virus (RSV) bronchiolitis. The medical records of 188 infants who were hospitalized during an initial episode of severe RSV bronchiolitis at 6 months of age or less were retrospectively reviewed. Our main outcome of interest was the development of subsequent recurrent wheezing by the age of 3years. Each infant's serum bilirubin concentration was extracted from their blood biochemical results. Seventy-one (37.8%) infants developed recurrent wheezing by the age of 3 and 117 (62.2%) did not. The serum total bilirubin, unconjugated bilirubin, and conjugated bilirubin levels at hospital admission were lower in infants who developed recurrent wheezing as compared to those who did not (p ＜ 0.001). The area under the receiver-operating characteristic curve of serum total bilirubin, unconjugated bilirubin, and conjugated bilirubin for the prediction of subsequent recurrent wheezing were 0.71 (95% confidence interval [CI], 0.64-0.78), 0.70 (95% CI, 0.63-0.78), and 0.67 (95% CI, 0.59-0.75), respectively. Higher admission serum total bilirubin levels were independently associated with a lower risk of development of subsequent recurrent wheezing (adjusted OR 0.17, p ＜ 0.001). During the first episode of severe RSV bronchiolitis in infants <6 months of age, moderately higher levels of serum bilirubin are associated with a reduced risk of developing subsequent recurrent wheezing by 3 years of age.

Associated factors with recurrent wheezing in infants: is there difference between the sexes?

ObjectiveIdentify associated factors for recurrent wheezing (RW) in male and female infants. MethodsCross-sectional multicentric study using the standardized questionnaire from the Estudio Internacional sobre Sibilancias en Lactantes (EISL). The questionnaire was applied to parents of 9345 infants aged 12–15 months at the time of immunization/routine visits. ResultsOne thousand two hundred and sixty-one (13.5%) males and nine hundred sixty-three (10.3%) females have had RW (≥3 episodes), respectively (p10 colds episodes (OR = 3.46; IC 95% 2.35–5.07), air pollution (OR = 1.33; IC 95% 1.12–1.59), molds at home (OR = 1.23; IC 95% 1.03–1.47), Afro-descendants (OR = 1.42; IC 95% 1.20–1.69), bronchopneumonia (OR = 1.41; IC; 1.11–1.78), severe episodes of wheezing in the first year (OR = 1.56; IC 95% 1.29–1.89), treatment with bronchodilators (OR = 1.60; IC 95% 1.22–2,1) and treatment with oral corticosteroids (OR = 1,23; IC 95% 0.99–1,52). Associated factors for RW for females were passive smoking (OR = 1.24; IC 95% 1.01−1,51), parents diagnosed with asthma (OR = 1.32; IC 95% 1,08−1,62), parents with allergic rhinitis (OR = 1.26; IC 95% 1.04–1.53), daycare attendance (OR = 1.48; IC 95% 1.17−1,88), colds in the first 6 months of life (OR = 2.19; IC 95% 1.69–2.82), personal diagnosis of asthma (OR = 1.84; IC 95% 1.39–2.44), emergency room visits (OR = 1.78; IC 95% 1.44–2.21), nighttime symptoms (OR = 2.89; IC 95% 2.34–3.53) and updated immunization (OR = 0.62; IC 95% 0.41−0.96). ConclusionThere are differences in associated factors for RW between genders. Identification of these differences could be useful to the approach and management of RW between boys and girls.

DIAGNOSTIC PROBLEMS AND RISK FACTORS OF BULLOUS EMPHYSEMA IN YOUNG ADULT

Bullous emphysema is a condition with the appearance of pathological bullae in the lungs caused by chronic obstruction of the airways. Bullae itself is thin-walled, air-filled pathological spaces, located in the lung parenchyma. It can be caused by congenital or genetic disease without previous lung disease or complications from COPD. Under special conditions, bullae can appear at a young age with several risk factors and underlying causes, such as COPD at a young age, genetic disorders, and cystic fibrosis. Several diseases that lead to COPD at a young age are Asthma in children, Recurrent Wheezing Infants (RWI), Broncho Pulmonary Dysplasia (BPD), Primary Ciliary Dyskinesia (PCD), Non-Cystic Fibrosis Bronchiectasis (NCFB), Plastic Bronchitis (PB), cystic fibrosis, and Bronchiolitis Obliterans (BO). A 25 year-old-woman with bullous emphysema causing a spontaneous pneumothorax, with suspected cyst rupture was reported. Among all lung diseases that can cause bullous emphysema at a young age, cystic fibrosis is the closest to our case. It needs further examination such as chromosome test and chloride sweat test analysis, and the possibility of Alfa-1 Antitrypsin (AAT) deficiency, cannot be ruled out.

Clinical significance of asthma predictive index, Etoaxin, interleukin-4, interferon-γ in infants with recurrent wheezing

Objective To investigate the clinical significance of asthma prediction index (API), Eotaxin(Eot), interleukin-4 (IL-4), interferon-γ (IFN-γ), eosinophil (Eos) in predicting recurrent wheezing in infants. Methods Ninety-six infants with first wheezing attack due to bronchiolitis from April 2015 to April 2016 at the Department of Pediatrics, the Second Hospital of Tianjin Medical University were selected.The medical history and other clinical data were collected, and the peripheral blood samples were collected to detect Eot, IL-4, IFN-γ, Eos count and serum specific immunoglobulin E(sIgE). Then all infants were followed up by telephone until 2-year-old to find whether recurrent wheezing attack occurred and then API was calculated.According to the recurrent wheezing times during the follow-up, they were divided into 2 groups: the observation group (recurrent attacks≥2 times, 33 cases) and the control group (no recurrent wheezing during follow-up, 60 cases). The infants in the observation group were divided into the API positive group (18 cases) and the API negative group (14 cases) according to API.The differences in clinical data and peripheral blood indexes were analyzed by independent sample t test for measuring data and χ2 test for counting data. Results Thirty-three cases (35.48%) infants in the study had recurrent wheezing attacks within 2 years followed by bronchiolitis.The average age of the recurrent wheezing attack was (13.59±5.89) months.Compared with the control group, the levels of serum Eot[(135.45±44.45) ng/L vs.(110.91±22.50) ng/L, t=3.44, P 0.05). The level of serum Eot [(146.59±59.35) ng/L vs.(114.14±13.60) ng/L, t=3.71, P<0.05], airway sIgE[45.00%(9/20 cases) vs.0(0/6 case), χ2=4.13, P<0.05]and food allergens sIgE [50.0%(10/20 cases) vs.0(0/6 case), χ2=4.88, P<0.05)] in the API positive group was higher than that in the API negative group, and the differences were statistically significant. Conclusions The elevated serum Eot levels during the first asthmatic attack of bronchiolitis in infants and food sIgE positive levels suggest an increased risk of recurrent wheezing, and the elevated serum Eot levels and sIgE positive levels are associated with API positive levels. Key words: Infant wheezing; Eotaxin; Interleukin-4; Asthma predictive index

RSV-hRV co-infection is a risk factor for recurrent bronchial obstruction and early sensitization 3 years after bronchiolitis.

To assess risk factors of recurrent bronchial obstruction and allergic sensitization 3 years after an episode of acute bronchiolitis, whether after ambulatory care treatment or hospitalization. A monocentric prospective longitudinal study including infants aged under 1 year with acute bronchiolitis was performed, with clinical (severity score), biological (serum Krebs von den Lungen 6 antigen), and viral (14 virus by naso‐pharyngeal suction detection) assessments. Follow‐up included a quaterly telephone interview, and a final clinical examination at 3 years. Biological markers of atopy were also measured in peripheral blood, including specific IgEs towards aero‐ and food allergens. Complete data were available for 154 children. 46.8% of them had recurrent wheezing (RW). No difference was found according to initial severity, care at home or in the hospital, respiratory virus involved, or existence of co‐infection. A familial history of atopy was identified as a risk factor for recurrent bronchial obstruction (60% for RW infants versus 39%, P = 0.02), as living in an apartment (35% versus 15%, P = 0.002). 18.6% of the infants were sensitized, with 48.1% of them sensitized to aeroallergens and 81.5% to food allergens. Multivariate analysis confirmed that a familial history of atopy (P = 0.02) and initial co‐infection RSV‐hRV (P = 0.02) were correlated with the risk of sensitization to aeroallergens at 3 years. Familial history of atopy and RSV‐hRV co‐infection are risk factors for recurrent bronchial obstruction and sensitization.

Changes in the prevalence and severity of recurrent wheezing in infants: The results of two surveys administered 7 years apart

ABSTRACTObjective:To identify changes in the prevalence and severity of recurrent wheezing (RW) in infants using data obtained from two surveys administered seven years apart.Methods: A cross-sectional, international, population-based study in infants aged 12–15 months was conducted. Data were obtained from two surveys (S1 and S2, in 2005 and 2012, respectively) using the same methodology in three large Latin American cities: Curitiba (Brazil), São Paulo (Brazil), and Santiago (Chile).Results: A decrease in the overall prevalence of RW was identified between S1 (23.3%) and S2 (20.4%), p = 0.004, but it was mainly driven by the reduction observed in São Paulo; in Curitiba and Santiago, this change was not significant. The mean prevalence of the following RW severity indicators remained high and stable: severe wheezing episodes (56.9% in S1 and 54.2% in S2, p = 0.32) and emergency department (ED) visits for wheezing (S1 = 68.1%, S2 70.9%, p = 0.21). A significant increase in admissions for wheezing (21.1% to 26.7%, p = 0.004) was observed. In Curitiba and São Paulo, there were significant increases in the prevalence of physician-diagnosed asthma and in the use of inhaled corticosteroids and oral antileukotrienes.Conclusions: The prevalence and severity of RW during the first year of life remained high over time, with remarkably high rates of ED visits, admissions for wheezing and use of asthma medications. This study suggests the need for considering early asthma diagnosis and to establish an appropriate treatment in infants with recurrent and severe asthma-like symptoms.

Risk factors for recurrent wheezing in the first year of life in the city of Córdoba, Argentina

BackgroundWheezing is a very common respiratory symptom in infants. The prevalence of wheezing in infants, conducted in developed countries shows prevalence rates ranging between 20% and 30%. However, we do not know the risk factors in our population of wheezing infants. MethodsA standardised written questionnaire (WQ-P1-EISL) in infants between 12 and 18 months of age residing in the city of Cordoba was used; population/sample included 1031 infants. Recurrent wheezing (RW) was defined as three or more episodes of wheezing reported by the parents during the first 12 months of life. Data obtained were coded in Epi-Info™ (version 7) and statistically analysed with SPSS (version 17.5) software in Spanish. Parametric tests (one-way ANOVA) were performed for identifying significantly associated variables. ResultsThe prevalence of wheezing infants was 39.7%; recurrent wheezing 33%; and severe wheezing 14.7%; 13.7% had pneumonia before the first year and of these 6.3% were hospitalised, multiple variables as risk factors for wheezing were found such as: >6 high airway infections and bronchiolitis in the first three months of life, smokers who smoke in the home among other risk factors and protective factors in those who have an elevated socioeconomic status. ConclusionIt is known that persistent respiratory problems in children due to low socioeconomic status is a risk factor for wheezing, pneumonia and could be a determining factor in the prevalence and severity of RW in infants. Research suggests that there are areas for improvement in the implementation of new educational strategies.

Recurrent Wheezing in Infants: A Population-Based Study.

Recurrent wheezing (RW) has a significant impact on infants, caregivers, and society, but morbidity and related medical resource utilization (MRU) have not been thoroughly explored. The burden of RW needs to be documented with population-based data. The objective was to assess the characteristics, medical management, and MRU of RW infants identified from national claims data.Infants aged from 6 to 24 months, receiving ≥2 dispensations of respiratory drugs within 3 months, and presenting a marker of poor control (index date), were selected. During the 6 months after index date, MRU was described in the cohort and among 3 subgroups with more severe RW, defined as ≥4 dispensations of respiratory drugs, ≥3 dispensations of oral corticosteroids (OCS), or ≥1 hospitalization for respiratory symptoms.A total of 115,489 infants had RW, corresponding to 8.2% of subjects in this age group. During follow-up, 68.7% of infants received inhaled corticosteroids, but only 1.8 U (unit) were dispensed over 6 months, suggesting discontinuous use. Control was mostly inadequate: 61.7% of subjects received OCS, 80.2% antibiotics, and 71.2% short-acting beta-agonists, and medical/paramedical visits were numerous, particularly for physiotherapy. Severe RW concerned 39.0% of the cohort; 32.8% and 11.7% of infants had repeated use of respiratory drugs and OCS, respectively, and 5.5% were hospitalized for respiratory symptoms.In this real-life nation-wide study, RW was common and infants had poor control and high MRU. Interventions are needed to support adequate use of controller therapy, and to improve medical care.

Treatment Patterns of Recurrent Wheezing in Infants: Two Surveys Separated By Seven Years

Treatment Patterns of Recurrent Wheezing in Infants: Two Surveys Separated By Seven Years

Factors associated to recurrent wheezing in infants under one year of age in the province of Salamanca, Spain: Is intervention possible? A predictive model

ObjectivesWheezing is a very common problem in infants in the first months of life. The objective of this study is to identify risk factors that may be acted upon in order to modify the evolution of recurrent wheezing in the first months of life, and to develop a model based on certain factors associated to recurrent wheezing in nursing infants capable of predicting the probability of developing recurrent wheezing in the first year of life. MethodsThe sample was drawn from a cross-sectional, multicentre, descriptive epidemiological study based on the general population. A total of 1164 children were studied, corresponding to a questionnaire response rate of 71%. The questionnaire of the Estudio Internacional de Sibilancias en Lactantes (EISL) was used. Multiple logistic regression analysis was used to estimate the probability of developing recurrent wheezing and to quantify the contribution of each individual variable in the presence of the rest. ResultsInfants presenting eczema and attending nursery school, with a mother who has asthma, smoked during the third trimester of pregnancy, and did not consume a Mediterranean diet during pregnancy were found to have a probability of 79.7% of developing recurrent wheezing in the first year of life. In contrast, infants with none of these factors were seen to have a probability of only 4.1% of developing recurrent wheezing in the first year of life. These results in turn varied according to modifications in the risk or protective factors. ConclusionsThe mathematical model estimated the probability of developing recurrent wheezing in infants under one year of age in the province of Salamanca (Spain), according to the risk or protective factors associated to recurrent wheezing to which the infants are or have been exposed.

Recurrent Wheezing in Infants and Young Children and Bronchial Hyper- Responsiveness

Recurrent Wheezing in Infants and Young Children and Bronchial Hyper- Responsiveness

Association between healthy eating in pregnancy and allergic status of the offspring in childhood

During the past few decades there has been a steady increase in the prevalence of noncommunicable diseases, including allergic disease. Changing lifestyle and subsequent diet may explain this increase seen in the prevalence of atopic disease. Epidemiologic evidence also suggests that diet may be key in the prevention of allergic disease. [1] There are 3 important characteristics in terms of the maternal diet that have been investigated for the prevention of allergic disease: (1) the role of particular nutrients, such as vitamins (A, D, and E), zinc, and fatty acids; (2) the role of particular foods, such as fruits and vegetables and fish; and (3) the total dietary intake, such as a Mediterranean diet or a healthy diet. Research using the healthy eating index tool, specific to the pregnancy diet, found no association between overall healthy eating score and recurrent wheeze in infants at the age of 3 years. [2] However, maternal intake of celery and citrus fruit specifically has been associated with an increased risk of sensitization to food allergens in 2-year-olds. [3] One case-control study found no effect of consumption of fish, butter, and margarine on the development of atopic sensitization in the offspring of allergic mothers; however, a protective effect of fish intake (2–3 times a week or more) was identified in the nonallergic mothers' group with the risk of food sensitization in the offspring reduced by greater than a third. [4] Thus, the question is whether the associations seen are due to the individual nutrients or foods or whether it is part of an overall nutritional composition of the weaning diet. In this study, we aimed to investigate whether maternal diet, specifically seafood intake during pregnancy, is associated with the infant's allergic outcomes in a well-characterized birth cohort with allergy at 3 and 10 years of age.

Prevalence, Severity, and Treatment of Recurrent Wheezing During the First Year of Life: A Cross-Sectional Study of 12,405 Latin American Infants.

PurposeThis study aimed to determine the prevalence and severity of recurrent wheezing (RW) defined as ≥3 episodes of wheezing, risk factors, and treatments prescribed during the first year of life in Latin American infants.MethodsIn this international, cross-sectional, and community-based study, parents of 12,405 infants from 11 centers in 6 South American countries (Argentina, Brazil, Chile, Colombia, Peru, and Uruguay) completed a questionnaire about wheezing and associated risk/protective factors, asthma medications, and the frequency of and indications for the prescription of antibiotics and paracetamol during the first year of life.ResultsThe prevalence of RW was 16.6% (95% CI 16.0-17.3); of the 12,405 infants, 72.7% (95% CI 70.7-74.6) visited the Emergency Department for wheezing, and 29.7% (27.7-31.7) was admitted. Regarding treatment, 49.1% of RW infants received inhaled corticosteroids, 55.7% oral corticosteroids, 26.3% antileukotrienes, 22.9% antibiotics ≥4 times mainly for common colds, wheezing, and pharyngitis, and 57.5% paracetamol ≥4 times. Tobacco smoking during pregnancy, household income per month <1,000 USD, history of parental asthma, male gender, and nursery school attendance were significant risk factors for higher prevalence and severity of RW, whereas breast-feeding for at least 3 months was a significant protective factor. Pneumonia and admissions for pneumonia were significantly higher in infants with RW as compared to the whole sample (3.5-fold and 3.7-fold, respectively).ConclusionsRW affects 1.6 out of 10 infants during the first year of life, with a high prevalence of severe episodes, frequent visits to the Emergency Department, and frequent admissions for wheezing. Besides the elevated prescription of asthma medications, there is an excessive use of antibiotics and paracetamol in infants with RW and also in the whole sample, which is mainly related to common colds.

The Role of Human Milk Immunomodulators in Protecting Against Viral Bronchiolitis and Development of Chronic Wheezing Illness.

Infants who are breastfed are at an immunological advantage when compared with formula fed infants, evidenced by decreased incidence of infections and diminished propensity for long term conditions, including chronic wheeze and/or asthma. Exclusive breastfeeding reduces the duration of hospital admission, risk of respiratory failure and requirement for supplemental oxygen in infants hospitalised with bronchiolitis suggesting a potentially protective mechanism. This review examines the evidence and potential pathways for protection by immunomodulatory factors in human milk against the most common viral cause of bronchiolitis, respiratory syncytial virus (RSV), and subsequent recurrent wheeze in infants. Further investigations into the interplay between respiratory virus infections such as RSV and how they affect, and are affected by, human milk immunomodulators is necessary if we are to gain a true understanding of how breastfeeding protects many infants but not all against infections, and how this relates to long-term protection against conditions such as chronic wheezing illness or asthma.

PO-0359 How To Select The Sweat Test Candidate. 10 Years Of Experience In Screening For Cystic Fibrosis In Children

Background Sweat test (ST) remains gold standard in cystic fibrosis (CF) diagnosis. Alarm symptoms are age-related. Aims Retrospective review of cases subjected to ST. Methods Patients were selected by paediatricians, neonatologists, surgeons, based on suggestive symptoms, personal (PH) and familial history (FH). Inclusion criteria: for 0–1 month age group, patients with PH of atelectasis, meconium ileus, intussusception; 1–12 months, recurrent wheezing (RW), failure to thrive (FTT); 1–5 years, previous group symptoms, plus chronic cough/diarrhoea; >5 years, 1–5 years symptoms, plus recurrent pancreatitis/sinusitis. For all age, patients with PH of salty taste of sweat (STS), salt wasting syndrome, heat shock (HS), and FH of CF, azoospermia. ST was performed with Nanoduct system. Values 80 positive. Normal values patients were eventually retested, those with equivocal at least once, those with positive mandatory twice. Results Were performed 406 ST (344 patients): at 0–1 month 11 tests (45,4% peritonitis), at 1–12 months 175(65,5% RW), at 1–5 years 108(25,9% FTT), at >5 years 50(62,5% repeated pneumonia-RP). 4 tests equivocal, 5 false positive, 6 positive (5 infants: 1 RW, 1 HS, 2 atelectasis, 1 STS; 1 male 4 years old RP). Relating to age, only 1 positive from 141 RW infants (p 0,03) and 1 from 15 RP children; 2 positive from 6 atelectasis infants (p 0,0001), 1 from 2 HS and 1 from 2 STS infants (p 0,0002). Neither pancreatitis, FTT or positive FH. Conclusions Great attention on infants with other symptoms than classical ones: higher statistical significance for STS, HS, atelectasis.

Risk Factors for Recurrent Wheezing in Infants

ResumoIntrodução: a sibilância é um dos sintomas respiratórios mais comuns na infância. Independentemente da causa, é motivo de procura por atendimento médico em serviços de urgência, sobretudo se há recorrência dos episódios. Muito frequente na infância, a sibilância de repetição tem seus primeiros episódios no primeiro ano de vida. Objetivo: verificar os fatores de risco para sibilância recorrente em lactentes no primeiro ano de vida. Método: pesquisa de campo do tipo exploratória, transversal com abordagem quantitativa, onde foi aplicado um questionário padronizado do Estudo Internacional de Sibilância em Lactentes, traduzido e validado no Brasil, constituído por questões objetivas. Foram questionadas 40 mães cadastradas em duas Unidades de Saúde da Família. Resultados: os fatores de risco encontrados: tabagismo durante a gestação, histórico familiar de asma, rinite e dermatite alérgica, presença de pelo menos um animal doméstico em domicílio na época do nascimento e idade do primeiro resfriado menor ou igual a três meses de vida. Não foram encontradas relações significativas entre sibilância e gênero masculino, amamentação exclusiva e quantidade de resfriados no primeiro ano de vida. Conclusão: mesmo utilizando um instrumento de pesquisa padronizado, é notória a discrepância nos resultados encontrados.

Latitude modifies the effect size of factors related to recurrent wheeze in the first year of life

Although the association between latitude and asthma prevalence has been studied to a certain extent, its influence on the magnitude of the association of risk/protective factors with recurrent wheeze in infants has never been reported. The adjusted odd ratios (aOR) of various risk/protective factors for recurrent wheeze from 31,920 infants from 19 centres of the "Estudio Internacional de Sibilacias en Lactantes" (EISL) in very different parts of the world were used to build a meta-regression using the strength of the aOR of each factor as dependent variable and centre latitude as explanatory variable. The meta-regression was further adjusted for continent. There was a positive significant correlation between latitude and the magnitude of the aOR between recurrent wheeze and having cold(s) during the first three months of life (p = 0.004); attending a nursery school (p = 0.011); and having additional siblings (p = 0.003). Furthermore, there was a negative correlation for having been breastfed for at least three months (p = 0.044). Heterogeneity (as measured by I2) of the magnitude of aORs between centres was quite high except for breast feeding: 73.1% for colds; 66.9% for nursery school; 52.6% for additional siblings; and 18.1% for breast feeding. Latitude explained a considerable amount of that heterogeneity: 63.8% for colds; 52.8% for nursery school; 86.6% for additional siblings; and 100% for breast feeding, probably as a consequence of its low heterogeneity. The magnitude in which some risk/protective factors are associated to recurrent wheeze during the first year of life varies significantly with latitude.

478 Post-Bronchiolitis Recurrent Wheezing in Children Under 2 Years of Age - A Clinical Epidemiological Study

ObjectivesThe research involved tracing some causality relationships among acute bronchiolitis, post-bronchiolitis recurrent wheezing and/or the atopic field.Material and methodThe study group was made up of 118 cases of acute bronchiolitis...

Leukocytes from wheezing infants release lower amounts of IL-12 and IFN-γ compared to non-wheezing infants

This study investigated environmental endotoxin exposure during early life, sensitization to aeroallergens, the production of cytokines by LPS-stimulated leukocytes, and the development of a wheezing phenotype in a prospective cohort of infants with high risk of developing allergic diseases. Eighty-four infants were followed from birth until 30 months of age. We assessed endotoxin concentration in house dust of their homes during the first 6 months of life. At age 30 months they were clinically evaluated to determine the development of wheezing and other clinical events, were skin prick tested, and had blood samples collected for the evaluation of cytokine release by LPS-stimulated peripheral blood mononuclear cells (PBMC). The level of endotoxin exposure during early life was not associated with development of a wheezing phenotype. On the other hand a higher incidence of respiratory infections occurred among recurrent wheezing (RW) infants. PBMC from RW children exposed to higher levels of environmental endotoxin (above 50 EU/mg) released less Interleukin (IL)-12p70 and IFN-γ compared to the non-RW group. TNF-α, IL-10, IL-4, IL-5, and IL17 production by LPS-stimulated PBMC from RW and non-RW children was equivalent in both groups of environmental endotoxin exposure. In this prospective cohort of infants with high risk of developing allergic diseases we observed that RW and non-RW children were exposed to similar levels of endotoxin early in life. LPS-stimulated PBMC from RW infants exposed to higher levels of endotoxin released significantly less IL-12 and IFN-γ compared to non-RW infants.

539 Asthma Treatment May Be Useful to Treat Recurrent Wheezing in Infancy.

BackgroundThere are controversies in treating recurrent wheezing (≥3 episodes) in pre-school children. The aim of this study was to verify changes in treatment of recurrent wheezing infants.MethodsCross-sectional study using a standardized and validated questionnaire (EISL: Estudio Internacional sobre Sibilancias en Lactantes) that covers physician diagnosis of asthma, and frequency, severity, and treatment of wheezing episodes. Regarding treatment specific questions are: Has your baby been treated with inhaled short-acting β2-agonists by metered dose inhaler or nebulizer? Has your baby been treated with inhaled corticosteroids? Has your baby been treated with antileukotrienes? Has your baby been treated with oral corticosteroids? Parents of infants, ages 12 to 15 months that attended to Health Centers for routine immunization were interviewed between August/2005 to December/2006 (EISL Phase I) and September/2009 to September/2010 (EISL Phase III). Categorical variables are showed as proportion and differences verified by chi-square test.ResultsThree thousand and 3 parents of infants answered questionnaire in the EISL Phase I and 22.6% had recurrent wheezing episodes. Five years later, in the EISL Phase III, 1003 parents participated in the survey and 19.8% had recurrent wheezing (P = 0.1). Inhaled short-acting β2-agonists continued to be prescribed in the same frequency (89.6% vs 86.5%, P = 0.21), however anti-asthmatic drugs were more used [antileukotrienes (6.9% vs 33%, P < 0.001), inhaled steroids (23.6% vs 37.5%, P = 0.001) and oral steroids (18.6% vs 26.5%, P = 0.01)] and doctor diagnosis of asthma has increased (16.2% vs 23%, P = 0.03). There were reductions on night-time symptoms (73% vs 61.5%, P = 0.001), severity (59.3% vs 42%, P = 0.001) and emergency room visits (69.3% vs 41.5%, P < 0.001) for recurrent wheezing infants, but no difference was seen in hospitalization (17.1% vs 12.5%, P = 0.12).ConclusionsRecurrent wheezing treatment in infancy has increased in past years and may have contributed for reducing emergency room visits, night-time symptoms and severity for wheezing infants.