Wheezing during the first year of life in infants from low-income population: a descriptive study

doi:10.1157/13080928

Allergologia et Immunopathologia

Volume 33, Issue 5, 2005, Pages 257-263

https://doi.org/10.1157/13080928 Get rights and content

Abstract

Background

Recurrent wheezing (RW) plays an important role in the morbidity and mortality of children during the first year of life in developing regions and its actual incidence in those areas is virtually unknown.

Methods and results

This study describes the occurrence of wheezing during the first year of life in a birth cohort of 188 infants followed monthly and living in a poor urban area in Santiago de Chile. This study showed that 80.3 % of the infants in the cohort had one or more wheezing episode during the first year of life, 43.1 % had RW (3 or more wheezing episodes), 44.1 % had their first wheezing within the first three months of life and 13.3 % had pneumonia (PN). Having one or more episode of wheezing in the first three months of life was the main risk factor for suffering from RW during the first year and RW was a significant risk factor for having PN.

Conclusions

This study found a high prevalence of RW in infants from a low-income population during the first year of life with the disease starting very early in their lives, progressing with more frequent episodes and being significantly associated to PN, particularly in the first 6 months of life.

References (23)

F.J. López-Antuñano
Epidemiología de las infecciones respiratorias agudas en niños: panorama regional
Infecciones respiratorias agudas: fundamentos técnicos de las estrategias de control. Eds. Benguigui Y. 1997. PAHO/WHO,...
I.M. López et al.
Risk factors in infants with lower respiratory tract diseases
Rev Chil Pediatr
(1994)
F. Martínez et al.
Asthma and wheezing in the first six years of life
New England J Med
(1995)
R. Sporik et al.
Natural history of asthma in childhood. A birth-cohort study
Arch Dis Child
(1991)
C. Dezateux et al.
Impaired airwayfunction and wheezing in infancy. The influence of maternal smoking and a genetic predisposition to asthma
Am J Respir Crit Care Med
(1999)
D.R. Gold et al.
Predictors of repeated wheeze in the first year of life. The relative roles of cockroach, birth weight, acute lower respiratory illness, and maternal smoking
Am J Respir Crit Care Med
(1999)
S. Guerra et al.
Reduced Interferon gamma production and soluble CD14 levels in early life predict recurrent wheezing by 1 year of age
Am J Respir Crit Care Med
(2004)
C.C. Copenhaver et al.
Cytokine Response Patterns, Exposure to Viruses, and Respiratory Infections in the First Year of Life
Am J Respir Crit Care Med
(2004)
L. Bont et al.
Monocyte IL-10 Production during Respiratory Syncytial Virus Bronchiolitis Is Associated with Recurrent Wheezing in a One-Year Follow-up Study
Am J Respir Crit Care Med
(2000)

P.A. Margolis et al.

Lower respiratory illness in infants and low socioeconomic status

Am J Public Health

(1992)

Cited by (50)

Risk factors for recurrent wheezing in the first year of life in the city of Córdoba, Argentina
2017, Allergologia et Immunopathologia
Citation Excerpt :
Having a bathroom inside the home for the sibilant was a protective factor OR = 0.55 (0.3–0.8), p = 0.006; likewise for RW, OR = 0.4 (0.2–0.80), p = 0.004. This finding agrees with that reported by Mallol et al.6 with regard to the increased prevalence of wheezing in lower socioeconomic strata. The present study had limitations related to the cross-sectional design thereof and any errors that arise when surveying parents.
Wheezing 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.
A 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.
The 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.
It 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.
Inflammatory markers predict episodes of wheezing during the first year of life in Bangladesh
2016, Respiratory Medicine
Citation Excerpt :
Future studies will examine the etiology of the association between increased serum cytokines and level of retinol binding protein and wheezing to determine if enteropathogen burden or dietary vitamin A intake associate with serum retinol levels and wheezing in these children. Low family income has in other studies also been associated with increased episodes of wheezing in the 1st year of life, as has male gender [34,35]. In this study, these were independent of inflammation in multivariable analysis, suggesting that their potential to promote wheezing is through some mechanism other than inflammation.
Environmental factors that influence wheezing in early childhood in the developing world are not well understood and may be useful in predicting respiratory outcomes. Therefore, our objective was to determine the factors that can predict wheezing.
Children from Dhaka, Bangladesh were recruited at birth and episodes of wheezing were measured alongside nutritional, immunological and socioeconomic factors over a one-year period. Poisson Regression with variable selection was utilized to determine what factors were associated with wheezing.
Elevated serum IL-10 (rate ratio (RR) = 1.51, 95% confidence interval (CI): 1.22–1.87), IL-1β (RR = 1.55, 95% CI: 1.26–1.93) C-reactive protein (CRP) (RR = 1.41, 95% CI: 1.03–1.93) in early life, and male gender (RR = 1.52, 95% CI: 1.27–1.82) predicted increased wheezing episodes. Conversely, increased fecal alpha-1-antitrypsin (RR = 0.87, 95% CI: 0.76–1.00) and family income (RR = 0.98, 95% CI: 0.97–0.99) were associated with a decreased number of episodes of wheezing.
Systemic inflammation early in life, poverty, and male sex placed infants at risk of more episodes of wheezing during their first year of life. These results support the hypothesis that there is a link between inflammation in infancy and the development of respiratory illness later in life and provide specific biomarkers that can predict wheezing in a low-income country.
Prevalence and clinical characteristics of wheezing in children in the first year of life, living in Cuiabá, Mato Grosso, Brazil
2014, Revista Paulista de Pediatria
Determinar a prevalência e as características clínicas da sibilância em lactentes (12‐15 meses) residentes em Cuiabá (MT).
Métodos: Pais e/ou responsáveis pela criança foram entrevistados e responderam ao questionário escrito padronizado do “Estudio Internacional de Sibilancia en Lactantes” (EISL) ‐ fase 3, em unidades básicas de saúde por ocasião da vacinação de rotina ou durante visitas nos domicílios de crianças matriculadas nos programas de saúde da família no período de agosto de 2009 a novembro de 2010.
1060 pais e/ou responsáveis responderam ao questionário escrito, sendo 514 (48,5%) lactentes do sexo masculino. Dos lactentes, 294 (27,7%) tiveram pelo menos um episódio de sibilância no primeiro ano de vida, com início aos 5,8 ± 3,0 meses e predomínio em meninos. A prevalência de sibilância ocasional (<3 episódios de sibilância) foi 15% e a recorrente (≥3 episódios) foi 12,7%. Entre estes, o uso de broncodilatador inalado, corticosteroide oral, antileucotrieno, presença de sintomas noturnos, dificuldade para respirar e internação por sibilância foram significantemente mais frequentes. Diagnóstico médico de asma foi evidenciado em 28 (9,5%) dos lactentes sibilantes. Dos lactentes sibilantes, 80 (27,7%) relataram ocorrência prévia de pneumonia, sendo que 33 (11,2%) necessitaram internação para tratamento, porém não houve diferença entre os grupos de sibilantes.
A prevalência de sibilância recorrente em lactentes foi mais baixa em comparação a outros estudos brasileiros, assim como o diagnóstico médico de asma. Sibilância recorrente teve início precoce e alta morbidade.
To evaluate the prevalence and the clinical characteristics of wheezing in 12‐15 months old infants in the city of Cuiabá, Mato Grosso State, Midwest Brazil.
Parents and/or guardians of infants were interviewed and completed a written standardized questionnaire of the “Estudio Internacional de Sibilancia en Lactantes” (EISL) – phase 3 at primary health care clinics at the same day of children vaccination or at home, from August 2009 to November 2010.
1,060 parents and/or guardians completed the questionnaire, and 514 (48.5%) infants were male. Among the studied infants, 294 (27.7%) had at least one episode of wheezing during the first year of life, beggining at 5.8 ± 3.0 months of age, with a predominance of male patients. The prevalence of occasional wheezing (<3 episodes of wheezing) was 15.0% and recurrent wheezing (≥ 3 episodes) was 12.7%. Among the infants with recurrent wheezing, the use of inhaled β2‐agonist, oral corticosteroid, leukotriene receptor antagonist, as well as night symptoms, respiratory distress and hospitalization due to severe episodes were significantly more frequent. Physician‐diagnosed asthma was observed in 28 (9.5%) of the wheezing infants. Among the wheezing infants, 80 (27.7%) were diagnosed with pneumonia, of whom 33 (11.2%) required hospitalization, neverthless no differences between occasional and recurrent wheezing infants were found.
The prevalence of recurrent wheezing and physician‐diagnosed asthma in infants were lower compared with those found in other Brazilian studies Recurrent wheezing had early onset and high morbity.
Prevalence and severity of wheezing in the first year of life in the city of Santo André, Brazil
2014, Revista Paulista de Pediatria
Verificar a prevalência e a gravidade da sibilância no primeiro ano de vida em lactentes no município de Santo André.
Estudo transversal com aplicação de questionário escrito, padronizado e validado do estudo EISL (do espanhol: Estudio Internacional de Sibilancias en Lactantes) aos pais e/ou responsáveis por lactentes de 12 a 24 meses de idade, em unidades básicas de saúde, durante campanhas de vacinação em creches e escolas maternais. O questionário consiste de questões sobre características demográficas, presença de sibilância, infecções respiratórias e fatores de risco. Os dados obtidos foram analisados com o Statistical Package for the Social Sciences for Windows, versão 20.0 (SPSS inc., Chicago, Il, EUA). A regressão logística foi aplicada para analisar as variáveis associadas à presença de sibilos recorrentes.
Do total de 1.028 lactentes estudados, 48,5% apresentaram um ou mais episódios de sibilância nos primeiros 12 meses de vida (sibilância alguma vez) e 23,9%, três ou mais episódios (sibilância recorrente). Sintomas noturnos, dificuldade intensa para respirar e visitas à emergência estiveram presentes em 67,3%, 42,4% e 60,7% dos lactentes, respectivamente, sendo que 19,4% foram hospitalizados e 11,0% tiveram diagnóstico médico de asma. O uso de β2–agonistas, corticoides inalatórios, corticoides orais e antagonistas do receptor de leucotrienos foram observados em 88,8%, 21,0%, 54,9% e 3,2% das crianças com sibilância, respectivamente. Uso de corticoide oral, percepção de falta de ar pelos pais, diagnóstico de asma, pneumonia e hospitalização por pneumonia foram mais frequentes entre os sibilantes recorrentes (p<0,001).
No município de Santo André, cerca da metade dos lactentes estudados apresentava pelo menos um episódio de sibilância no primeiro ano de vida, e metade deles apresentou sibilância recorrente, com início precoce e alta morbidade.
To determine the prevalence and the severity of wheezing in the first year of life for infants who live in Santo André, São Paulo, Brazil.
Cross sectional study with the administration of the Estudio Internacional de Sibilancias en Lactantes (EISL), which is a standardized and validated written questionnaire applied to parents and/or guardians of infants aged 12–24 months treated at primary health units, vaccination centers, day care centers, or kindergartens. The questionnaire consisted of questions regarding demographic characteristics, presence of wheezing, respiratory infections, and risk factors. Results were analyzed using the SPSS for Windows, 20.0 (SPSS Inc. – Chicago, Il, United States). Logistic regression was applied to verify variables associated to recurrent wheezing.
Among the 1,028 infants studied, 48.5% had one or more episodes of wheezing during the first 12 months of life (wheezing once), and 23.9% had three or more episodes (recurrent wheezing). Nocturnal symptoms, severe breathing difficulty, and visits to the emergency room were observed in 67.3%, 42.4%, and 60.7% of infants, respectively. Among the studied infants, 19.4% were hospitalized, and 11.0% had a medical diagnosis of asthma in the first year of life. Use of β2-agonists, inhaled corticosteroids, oral corticosteroids, and leukotriene receptor antagonists were observed in 88.8%, 21.0%, 54.9%, and 3.2% of children with wheezing, respectively. Use of oral corticosteroids, perception of breathlessness by parents, diagnosis of asthma, pneumonia, and hospitalization for pneumonia were more frequent among infants with recurrent wheezing (p<0.001).
In the city of Santo André, approximately half of infants had at least one episode of wheezing in the first year of life, and almost 25% had recurrent wheezing. Wheezing disorders in Santo André have early onset and high morbidity.
Risk factors associated with wheezing in infants
2013, Jornal de Pediatria
Citation Excerpt :
As this was a cross-sectional study, wheezing could not be characterized as a triggering or consequent factor of pulmonary infections, but pneumonia was an important risk factor in this study. In a cohort of newborns of low socioeconomic class in Santiago (Chile), followed during the first year of life, a prevalence of pneumonia of 13.3%, was observed, and the presence of recurrent wheezing during the first three months of life was strongly associated with the diagnosis of pneumonia.23 EISL publications in Brazil also found the presence of pneumonia in the first year of life as a risk factor associated with wheezing.17,18,24
to identify possible risk factors associated with wheezing in infants (12-15 months-old) in the state of Mato Grosso, Brazil.
this was a cross-sectional study performed by applying a standardized written questionnaire from the international study on wheezing in infants (Estudio Internacional de Sibilancia en Lactantes - EISL), phase 3. Parents and/or guardians of infants were interviewed at primary health care clinics or at home from August of 2009 to November of 2010. Factors associated to wheezing were studied using bivariate and multivariate analysis (using the Statistical Package for Social Sciences [SPSS] v.18.0), and expressed as odds ratios (OR) and 95% confidence intervals (95% CI).
the written questionnaire was answered by 1,060 parents and/or guardians. The risk factors for wheezing were: history of asthma in the family [mother (OR = 1.62; 95% CI = 1.07-2.43); father (OR = 1.98; 95% CI = 1.22-3.23); siblings (OR = 2.13; 95% CI = 1.18-3.87)]; history of previous pneumonia (OR = 10.80; 95% CI = 4.52-25.77); having had more than six upper respiratory tract infections (URTIs) (OR = 2.95; 95% CI = 2.11-4.14); having had first URTI before the third month of life (OR = 1.50; 95% CI = 1.04-2.17); living in a moderately polluted area (OR = 1.59; 95% CI = 1.08-2.33); paracetamol use for URTI (OR = 2.13; 95% CI = 1.54-2.95); and antibiotic use for skin infection (OR = 2.29; 95% CI = 1.18-4.46).
the study of risk factors for wheezing in the first year of life is important to help physicians identify young children at high risk of developing asthma and to improve public health prevention strategies in order to reduce the morbidity of wheezing in childhood.
identificar possíveis fatores de risco associados à sibilância em lactentes (12 a 15 meses) no estado de Mato Grosso, Brasil.
estudo transversal, utilizando o questionário escrito padronizado do Estudio Internacional de Sibilancia en Lactantes (EISL) – fase 3. Pais e/ou responsáveis pela criança foram entrevistados em Unidades Básicas de Saúde quando as procuravam para imunização de rotina ou durante visitas nos domicílios de crianças matriculadas nos programas de saúde da família, no período de agosto de 2009 a novembro de 2010. Fatores associados à sibilância foram avaliados utilizando análise bivariada e multivariada e expressos como odds ratio (OR) e intervalo de confiança 95% (IC95%).
ao todo, um mil e sessenta (n = 1.060) pais e/ou responsáveis responderam o questionário escrito. Os fatores de risco para sibilância foram: história familiar de asma [mãe (OR = 1,62; IC95%= 1,07-2,43); pai (OR = 1,98; IC95% = 1,22-3,23); irmãos (OR = 2,13; IC95% = 1,18-3,87)]; história prévia de pneumonia (OR = 10,8; IC 95% = 4,52-25,77); ter mais de seis infecções de vias aéreas superiores (IVAS) (OR = 2,95; IC95% = 2,11-4,14) e a primeira IVAS antes dos três meses de idade (OR = 1,50; IC95% = 1,04-2,17); residir em local com moderada poluição (OR = 1,59; IC95% = 1,08-2,33); uso de paracetamol por IVAS (OR = 2,13; IC95% = 1,54-2,95); e uso de antibiótico por infecção na pele (OR = 2,29; IC 95% = 1,18-4,46).
O estudo dos fatores de risco para sibilância no primeiro ano de vida é importante para auxiliar na identificação, entre os lactentes sibilantes, aqueles de alto risco para desenvolver asma, e para o desenvolvimento de estratégias de prevenção por políticas pública de saúde visando minimizar a morbidade da sibilância na infância.
Study of wheezing and its risk factors in the first year of life in the Province of Salamanca, Spain. The EISL Study
2012, Allergologia et Immunopathologia
Citation Excerpt :
The present study has focused on factors other than infection which may be of relevance in relation to both wheezing and RW. In this context, and coinciding with other studies, we found no significant differences in terms of patient sex19 – in contrast to other authors who report a higher prevalence among males.11,15,16,20 On the other hand, we found an association between wheezing and infant weight at birth (IWB) of under 1500 g.
To determine the prevalence of wheezing and its associated risk factors in infants in the first year of life in the province of Salamanca, Spain.
A multicentre, cross-sectional, descriptive epidemiological study was designed to evaluate a representative sample of 750 infants in the first year of life, born in the province of Salamanca between 1 June 2008 and 30 September 2009.
The study was based on a previously validated and standardised written questionnaire administered among the parents of those children seen for control at 12 months of age in any of the Primary Care centres in the province of Salamanca.
The recorded wheezing rate was 32.3%. Feeding and sleep were seen to be affected in 46.3% and 80.9% of the wheezing children, respectively, and parent activity was also altered in 39.3% of the cases.
A relationship was found between wheezing and nursery attendance (OR: 1.66, 95% confidence interval [1.19–2.31]); weight at birth >3500 g (OR: 1.45 [1.02–2.06]); the presence of eczema at this age (OR: 2.72 [1.75–4.24]); exclusive breastfeeding for <3 months (OR: 1.33 [0.98–1.81]); and maternal smoking during the last three months of pregnancy (OR: 1.60 [0.96–2.68]).
The prevalence of recurrent wheezing (defined as three or more episodes) was 11.9%. Significant differences were observed with respect to nursery attendance (OR: 1.71 [1.08–2.72]), the presence of eczema at this age (OR: 2.55 [1.48–4.42]), a history of maternal asthma (OR: 2.19 [1.08–4.44]) and exclusive breastfeeding for <3 months (OR: 1.53 [0.98–2.38]).
In the province of Salamanca, one third of the infants studied suffered wheezing in the first year of life. Infants exclusively breastfed for less than three months; attending a nursery; having suffered eczema; or with an asthmatic mother showed significantly more wheezing than the rest. Wheezing proved recurrent in 11.9% of the cases.

View all citing articles on Scopus

View full text

Original articlesWheezing during the first year of life in infants from low-income population: a descriptive study

Abstract

Background

Methods and results

Conclusions

Epidemiología de las infecciones respiratorias agudas en niños: panorama regional

Risk factors in infants with lower respiratory tract diseases

Rev Chil Pediatr

Asthma and wheezing in the first six years of life

New England J Med

Natural history of asthma in childhood. A birth-cohort study

Arch Dis Child

Impaired airwayfunction and wheezing in infancy. The influence of maternal smoking and a genetic predisposition to asthma

Am J Respir Crit Care Med

Predictors of repeated wheeze in the first year of life. The relative roles of cockroach, birth weight, acute lower respiratory illness, and maternal smoking

Am J Respir Crit Care Med

Reduced Interferon gamma production and soluble CD14 levels in early life predict recurrent wheezing by 1 year of age

Am J Respir Crit Care Med

Cytokine Response Patterns, Exposure to Viruses, and Respiratory Infections in the First Year of Life

Am J Respir Crit Care Med

Monocyte IL-10 Production during Respiratory Syncytial Virus Bronchiolitis Is Associated with Recurrent Wheezing in a One-Year Follow-up Study

Am J Respir Crit Care Med

Lower respiratory illness in infants and low socioeconomic status

Am J Public Health

Original articles
Wheezing during the first year of life in infants from low-income population: a descriptive study