Longitudinal trajectories of severe wheeze exacerbations from infancy to school age and their association with early‐life risk factors and late asthma outcomes

IntroductionPrevious studies which used data-driven methodologies have reported the existence of an exacerbation-prone asthma subtype, which is independent of asthma severity. However, longitudinal patterns of asthma exacerbations during childhood have not been studied. Objectives and ApproachWe sought to investigate whether there are distinct longitudinal trajectories of asthma exacerbations from infancy to school-age that could facilitate better understanding of the heterogeneity of asthma syndrome. We used longitudinal k-means modelling (an unsupervised data-driven method), to analyse linked primary care data from 916 participants in a population-based birth cohort study (Manchester Asthma and Allergy Study), to ascertain clusters of children with similar trajectories of asthma exacerbations during childhood (n=160). We tested the validity of these clusters in relation to lung function, airway hyperreactivity and inflammation, allergic sensitisation, and the use of asthma medication. ResultsA two-cluster model provided the optimal solution for our data set. Based on the pattern of exacerbations from infancy to age 8 years, we assigned the clusters as: “Early-onset frequent exacerbations (FE)” (n=10) and “Infrequent exacerbations (IE)” (n=150). Shorter duration of breastfeeding was the strongest risk factor for FE (median weeks 0 (IQR: 0-1.75) vs IE, median weeks 6 (IQR: 0-20), p<0.001). Children in the FE cluster were more likely to exhibit persistent wheeze (90% vs 47%, p=0.03) and have poorer lung function, more airway hyperreactivity, and more airway inflammation throughout childhood (Table 1). In a post-hoc analysis, when we compared children in the exacerbation clusters with those who have wheezed only (n=389), and those that wheezed but had no exacerbations (n=338), other early life risk factors such as atopic sensitisation (IE - RR: 3.2 (95%CI: 2.1-5.1), p<0.001) (FE - RR: 10.9 (95%CI: 2.1-57.7), p=0.004), exposure to tobacco smoke at birth (FE - RR: 2.8 (95%CI: 1.3-6.3) ,p=0.02), position in sibship (IE - RR: 1.5 (95%CI: 1.0-2.3), p=0.03), and day care attendance (IE - RR:0.6 (95%CI: 0.4-0.9), p=0.01) were significantly associated with exacerbations. Conclusion/ImplicationsWe have identified two distinct patterns of asthma exacerbations during childhood with different outcomes, early-life risk factors, and lung function when compared to children who wheeze, but have no exacerbations. These results indicate that exacerbations represent an independent susceptibility phenotype.

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Early life risk factors for asthma outcomes in a cohort of young adults

10.1183/13993003.congress-2016.pa324 ◽

2016 ◽

Author(s):

Elisha White ◽

Nicholas DeKlerk ◽

Elysia Hollams ◽

Graham Hall

Keyword(s):

Risk Factors ◽

Young Adults ◽

Early Life ◽

Asthma Outcomes

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Prevalence and early‐life risk factors of school age allergic multimorbidity – the EuroPrevall‐iFAAM birth cohort

Allergy ◽

10.1111/all.14857 ◽

2021 ◽

Author(s):

Sigurveig T Sigurdardottir ◽

Kristjan Jonasson ◽

Michael Clausen ◽

Kristin Lilja Bjornsdottir ◽

Sigridur Erla Sigurdardottir ◽

...

Keyword(s):

Risk Factors ◽

Birth Cohort ◽

Early Life ◽

School Age

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Early Life Wheeze and Risk Factors for Asthma—A Revisit at Age 7 in the GEWAC-Cohort

Children ◽

10.3390/children8060488 ◽

2021 ◽

Vol 8 (6) ◽

pp. 488

Author(s):

Idun Holmdahl ◽

Anastasia Filiou ◽

Katarina Stenberg Hammar ◽

Anna Asarnoj ◽

Magnus P. Borres ◽

...

Keyword(s):

Risk Factors ◽

Vitamin D ◽

Medical Care ◽

Cell Count ◽

Early Life ◽

Persistent Asthma ◽

School Age ◽

Healthy Controls ◽

Vitamin D Levels ◽

Airborne Allergens

One third of all toddlers are in need of medical care because of acute wheeze and many of these children have persistent asthma at school age. Our aims were to assess risk factors for and the prevalence of asthma at age 7 in a cohort of children suffering from an acute wheezing episode as toddlers. A total of 113 children, included during an acute wheezing episode (cases), and 54 healthy controls were followed prospectively from early pre-school age to 7 years. The protocol included questionnaires, ACT, FeNO, nasopharyngeal virus samples, blood sampling for cell count, vitamin D levels, and IgE to food and airborne allergens. The prevalence of asthma at age 7 was 70.8% among cases and 1.9% among controls (p < 0.001). Acute wheeze caused by rhinovirus (RV) infection at inclusion was more common among cases with asthma at age 7 compared to cases without asthma (p = 0.011) and this association remained significant following adjustment for infection with other viruses (OR 3.8, 95% CI 1.4–10.5). Cases with asthma at age 7 had been admitted to hospital more often (p = 0.024) and spent more days admitted (p = 0.01) during the year following inclusion compared to cases without asthma. RV infection stands out as the main associated factor for wheeze evolving to persistent asthma. Cases who developed asthma also had an increased need of hospital time and care for wheeze during the year after inclusion.

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Prediction of school-age IQ, academic achievement, and motor skills in children with positional plagiocephaly

Paediatrics & Child Health ◽

10.1093/pch/pxaa012 ◽

2020 ◽

Author(s):

Erin R Wallace ◽

Cindy Ola ◽

Brian G Leroux ◽

Matthew L Speltz ◽

Brent R Collett

Keyword(s):

Risk Factors ◽

Academic Achievement ◽

At Risk ◽

Motor Development ◽

Early Life ◽

Preschool Age ◽

Model Fit ◽

School Age Children ◽

School Age ◽

Positional Plagiocephaly

Abstract Introduction Children with positional plagiocephaly and/or brachycephaly (PPB) are at risk of early developmental delay, but little is known about early life factors associated with school-age neurodevelopment. This study examined associations of demographic characteristics, prenatal risk factors and early neurodevelopment assessment with school-age IQ, academic performance, and motor development in children with PPB. Methods The study sample consisted of 235 school-age children with PPB followed since infancy. Outcome measures included IQ using the Differential Ability Scales-Second Edition, academic achievement as measured by the Wechsler Individualized Achievement Tests-Third Edition), and motor function using the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition. Linear regression was used to examine the incremental improvement of model fit of demographics, prenatal and early life characteristics, severity of PPB, and neurodevelopment at ages 7, 18, and 36 months as measured by the Bayley-3 on school-age scores. Results Mean age at school-age assessment was 9.0 years. Adjusted r2 for demographic, prenatal, and early life risk factors ranged from 0.10 to 0.22. Addition of PPB severity and Bayley-3 measures at ages 7 and 18 months did not meaningfully change model fit. Adjusted r2 after inclusion of Bayley-3 at 36 months ranged from 0.35 to 0.41. Conclusion This study suggests that PPB severity and very early life neurodevelopment have little association with school-age neurodevelopment above and beyond demographic and early life risk factors. However, preschool-age neurodevelopmental assessment may still be useful in identifying children with PPB at risk for delay and who may benefit from early intervention.

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Early life wheeze and risk factors for subsequent asthma -- a revisit at age 7 years in the GEWAC-cohort

10.22541/au.160631106.67839963/v1 ◽

2020 ◽

Author(s):

Idun Holmdahl ◽

Anastasia Filiou ◽

Katarina Stenberg Hammar ◽

Anna Asarnoj ◽

Magnus Borres ◽

...

Keyword(s):

Risk Factors ◽

Vitamin D ◽

Risk Factor ◽

Early Life ◽

School Age ◽

Emergency Ward ◽

Recurrent Wheeze ◽

One Year ◽

Airborne Allergens

Background: One third of all toddlers are in need of medical care because of acute wheeze and many of these children continue to have asthma at school age. Our aim was to assess the prevalence of asthma among the children in GEWAC at age 7 years. And investigate why some children continue to have recurrent wheeze and asthma at school age. Methods: The study included 156 cases with acute wheeze, recruited from the paediatric emergency ward, Astrid Lindgren’s Children’s Hospital, Stockholm, Sweden and 102 age-matched controls. Cases attended a follow-up visit after 3 months, after one year and at age 7 years. The protocol included questionnaires, ACT, FENO, nasopharyngeal virus samples, blood sampling for cell count, Vitamin D and IgE to food and airborne allergens. Results: A total of 70.8 % of the cases and 1.9 % of the controls had asthma at age 7 (p<0.001). Acute wheeze caused by Rhinovirus (RV) infection at inclusion was more common among cases with asthma at age 7 compared to cases without asthma (p=0.011). When adjusting for other viruses, RV remained significantly associated with asthma at age 7 (OR 3.8 95% CI 1.4-10.5). Cases with asthma at age 7 had been admitted to hospital more often (p=0.024) and spent more days admitted (p=0.01) during the year following inclusion. Conclusion: Rhinovirus induced acute wheeze is a risk factor for asthma by age 7. Cases with asthma at age 7 were hospitalized more frequently and needed more inpatient time during the year after inclusion.

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