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S16 Outcomes of multiple trigger wheeze and exclusive viral wheeze in early childhood: A comparison across two population cohorts
  1. CN Cochrane1,
  2. BD Spycher2,
  3. R Granell3,
  4. JAC Sterne3,
  5. M Silverman4,
  6. AM Pescatore2,
  7. EA Gaillard2,
  8. CE Kuehni2,
  9. J Henderson3
  1. 1Royal United Hospital, Bath, UK
  2. 2Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
  3. 3School of Social and Community Medicine, University of Bristol, Bristol, UK
  4. 4Division of Child Health, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK

Abstract

Introduction Early childhood wheeze has been classified according to triggers; exclusive viral wheeze (EVW) and multiple trigger wheeze (MTW). It has been proposed that these phenotypes differ in their aetiology, severity and prognosis.

Objectives To examine the prevalence and symptom severity of EVW and MTW in 2–6 year olds. To evaluate the stability of these phenotypes over time, and their association with later wheeze.

Method In two longitudinal birth cohorts comprising 18,362 individuals, data on respiratory symptoms were collected at age 2, 4 and 6 years. Parent-reported triggers were used to classify wheeze as EVW or MTW for each 2-year period. Logistic regression analysis was used to estimate odds ratios for current wheeze and relative risk ratios for wheeze phenotypes versus no wheeze, at follow-up compared with baseline.

Results At 2 years 17.6% and 22.6% (cohorts 1 and 2 respectively) had wheeze, of which 55.2% and 56.3% had MTW. At 6 years 69.7% and 75.7% of children with wheeze had MTW.

Among children with wheeze at baseline, 58–76% with EVW and 46–67% with MTW were in remission 2 years later (cohort 1) and 14–20% and 4–11% (cohort 2).

MTW had greater reported symptom-severity at all time-points compared with EVW.

When adjusted for symptom-severity, children with EVW at baseline had relative risk ratios (RRR) of 2.9–7.4 and 4.1–15.5 (cohorts 1 and 2 respectively) for EVW and RRR 1.7–2.9 and 1.6–4.0 for MTW at follow-up. Children with MTW at baseline had RRR of 3.1–6.2 in cohort 1 and 3.6–15.6 in cohort 2 for MTW and 1.1–2.7 and 1.4–7.0 respectively for EVW at follow-up.

Conclusions When adjusted for symptom severity, wheezing phenotypes based on reported triggers remained stable between 2–6 years of age. Symptom-severity may be a more important determinant than triggers of future wheeze classification in young children.

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