Severe episodic viral wheeze in preschool children: High risk of asthma at age 5-10 years

Abstract

In population studies, most children with episodic viral wheeze (EVW) become symptom free by 6 years. We studied the outcome of children with severe EVW, treated and followed up in hospital. We followed up 78 children <4 years, managed by paediatricians for severe EVW, to the age of 5-10 years. We recorded respiratory symptoms, spirometry and exhaled nitric oxide (FeNO). At follow-up, 42 children (54%) had current wheeze or dyspnoea, and 52 (67%) had current asthma. There was no significant difference between children with and without current asthma in FEV1 (p00.420), but FeNO was higher in children with current asthma (median (interquartile range) 14.5 (11.25- 21.50) ppb) than in those without (12.0 (10.0-13.8) ppb, p00.020). Positive family history of asthma was the only factor associated with current asthma (odds ratio 8.77, 95% CI 2.88-26.69, p<0.001). This remained significant after adjustment for duration of follow-up, gender and parental smoking. Conclusion. Severe EVW at preschool age has a high risk of asthma at age 5-10 years, and this is reinforced by a positive family history of asthma and to elevated FeNO levels. © The Author(s) 2012.