Is There a Link Between Wheezing and Persistent Asthma in Young Children?

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childhood asthmaThis article summary is difficult to write, as it is likely one of the last articles that we will see published by Dr. Gail Shapiro, whose recent untimely death is a great loss for the medical community. She had a longstanding interest in childhood asthma and published this article to call attention to some of the factors that may be associated with persistent wheezing in young asthmatics who intermittently wheeze during their early years.

Shapiro noted that the level of bronchial hyperreactivity correlated with the persistence of wheezing in some studies that have tried to identify risk factors for persistent asthma. In addition, other features suggesting an increased risk of asthma persistence have included female gender, tobacco smoke exposure, parental history of asthma, and features of atopic disease (including rhinitis, eczema, and eosinophilia). She stated that the early expression of bronchial reactivity (eg, wheezing and coughing during viral infections) is a risk factor for persistent wheezing through childhood, with the earlier onset showing higher risk for increased disease severity compared with a later onset.

Shapiro noted that children with few episodes of wheezing during childhood, usually in the setting of viral infections, often outgrow their disease, whereas those who exhibit frequent and persistent wheezing through childhood more often continue wheezing into adulthood. Unfortunately, we have learned that early and aggressive use of inhaled corticosteroids has no beneficial long-term effect on the natural history of asthma, but it is very effective in controlling the symptoms and preventing exacerbations. In contrast, allergen avoidance and specific allergen immunotherapy (in those with allergen triggers) may alter the course of the disease and help prevent the development of asthma.

Viewpoint

Children who intermittently wheeze in the setting of viral infections during early childhood but who do not have concomitant risk factors (especially atopic disease) are less likely to have persistent wheezing into adulthood compared with those with more frequent and severe wheezing during their early years. In those with allergen triggers, it is appropriate to identify those triggers so that they can be minimized.

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