Chest
Volume 127, Issue 2, February 2005, Pages 502-508
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Clinical Investigations: Asthma
Early Life Risk Factors for Current Wheeze, Asthma, and Bronchial Hyperresponsiveness at 10 Years of Age

https://doi.org/10.1378/chest.127.2.502Get rights and content

Study objectives

We sought to identify early life factors (ie, first 4 years) associated with wheeze, asthma, and bronchial hyperresponsiveness (BHR) at age 10 years, comparing their relative influence for these conditions.

Methods

Children were seen at birth, and at 1, 2, 4, and 10 years of age in a whole-population birth cohort study (1,456 subjects). Information was collected prospectively on genetic and environmental risk factors. Skin-prick testing was performed at 4 years of age. Current wheeze (in the last 12 months) and currently diagnosed asthma (CDA) [ie, current wheeze and ever-diagnosed asthmatic subject] were recorded at 10 years of age when BHR was measured at bronchial challenge. Independent significant risk factors for these outcomes were identified by logistic regression.

Results

Independent significance for current wheeze occurred with maternal asthma (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.27 to 3.41) and paternal asthma (OR, 2.12; 95% CI 1.29 to 3.51), recurrent chest infections at 2 years (OR, 3.98; 95% CI, 2.36 to 6.70), atopy at 4 years of age (OR, 3.69; 95% CI, 2.36 to 5.76), eczema at 4 years of age (OR, 2.15; 95% CI, 1.24 to 3.73), and parental smoking at 4 years of age (OR, 2.18; 95% CI, 1.25 to 3.81). For CDA, significant factors were maternal asthma (OR, 2.26; 95% CI, 1.24 to 3.73), paternal asthma (OR, 2.30; 95% CI, 1.17 to 4.52), and sibling asthma (OR, 2.00; 95% CI, 1.16 to 3.43), recurrent chest infections at 1 year of age (OR, 2.67; 95% CI, 1.12 to 6.40) and 2 years of age (OR, 4.11; 95% CI, 2.06 to 8.18), atopy at 4 years of age (OR, 7.22; 95% CI, 4.13 to 12.62), parental smoking at 1 year of age (OR, 1.99; 95% CI, 1.15 to 3.45), and male gender (OR, 1.72; 95% CI, 1.01 to 2.95). For BHR, atopy at 4 years of age (OR, 5.38; 95% CI, 3.06 to 9.47) and high social class at birth (OR, 2.03; 95% CI, 1.16 to 3.53) proved to be significant.

Conclusions

Asthmatic heredity, predisposition to early life atopy, plus early passive smoke exposure and recurrent chest infections are important influences for the occurrence of wheeze and asthma at 10 years of age. BHR at 10 years of age has a narrower risk profile, suggesting that factors influencing wheezing symptom expression may differ from those predisposing the patient to BHR.

Section snippets

Materials and Methods

A whole-population birth cohort was established on the Isle of Wight in 1989 to prospectively study the natural history of childhood wheezing and to identify risk factors for the development of childhood wheezing and asthma. Approval for the study was obtained from the local research ethics committee. Of 1,536 children born between January 1, 1989, and February 28, 1990, informed consent was obtained for 1,456 subjects to be enrolled. Enrollment took place at birth, and information on family

ACKNOWLEDGEMENT

The authors gratefully acknowledge the cooperation of the children and parents who have participated in this study. We also thank Linda Terry, Gail Poulton, Heidi Savory, Tessa Booth, Linda Waterhouse, Andrew Gallini, Cathy Wilby, Rosemary Lisseter, and Roger Twiselton for their considerable assistance with many aspects of the 10-year follow-up of this study. Finally, we would like to highlight the role of the late Dr. David Hide in starting this study.

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