Repeated preschool wheeze may set the stage for long-term damage in lung function

May 7, 2014

Children who wheeze are at risk of developing damage that will affect their lung function by the age of 6 years, according to researchers at CHU Sainte-Justine Hospital and the University of Montreal. These appear to be persistent, even if asthma symptoms seem to disappear at least temporarily by school age in several cases. Children with recurrent symptoms that are severe enough to warrant a visit to the emergency department are particularly at risk of seeing their lung function affected. This may persist in adulthood and into their forties, even if they have gone through a period of asthma remission during their childhood or adolescence. Preschool wheezing could be a risk factor for to chronic obstructive pulmonary disease.

The findings were published in The Lancet by researchers and pediatricians Drs. Francine M. Ducharme and Sze Man Tse following a review of the outcomes of clinical studies undertaken on preschoolers over close to 25 years. Wheezing is a symptom characterized by a whistling sound when breathing and it affects 20% to 25% of Canadian under 6 years of age. Under-sixes visit the emergency three times more than all other age groups, resulting in at least one yearly visit for 2%-4% of them, a sizable number of whom will subsequently be admitted to hospital.

"Repeated wheezing is most often caused by asthma. However, the diagnosis is challenging because before 6 years of age, children are too young to go through the standard confirmatory test – spirometry," says Dr. Ducharme. "Yet the period before six years of age is clearly a period of increased vulnerability and is probably the best time to intervene – and possibly – prevent lasting damage."

Damage resulting from lack of long-term therapy

These data track the natural evolution of the asthma, as today's ill adults were the preschoolers 20 to 40 years ago: at that time, few effective treatments were available. "Our study shows that the most effective treatment of young children is the long-term use of low doses of inhaled corticosteroids. However, it is alarming to see that few young children are currently receiving over the long term, this treatment that has been known to be effective. So even today, these children are at risk of long-term damage to their lung," says Dr. Ducharme.

The importance of diagnosis

In many cases, asthmatic children are wrongly diagnosed as having bronchitis or pneumonia. "This is why it's essential to correctly diagnose the causes of childhood wheezing," Dre Sze Man Tse says. "In other cases, due to a lack of information, doctors hesitate to prescribe long-term treatment, and parents hesitate to administer it. If these children were treated daily with inhaled corticosteroids, they would avoid repeated ER visits and their quality of life would be improved, as would their whole family's." It is not yet known if the treatment prevents long-term damage.

A public health priority

Genetic factors, colds, exposure to tobacco and very early childhood rapid weight gain are known for repeated wheezing. "Early intervention to reduce medium and long-term lung damage resulting from preschool wheezing should be a public health priority," says Dre Ducharme. "Knowing that 48% of preschool children will wheeze at least once before the age of 6 years, and that a large proportion of them are improperly diagnosed or do not receive the inhaled corticosteroid whose effectiveness is well beyond any scientific doubt, we see in turn the great, needless expense for the health system and the risk of life-long, irreversible damage to these children."

Long-term preventative effect

CHU Sainte-Justine Hospital is one of few Canadian specialised paediatric centres that follows these patients with pulmonary function tests specially adapted for children 3 years and up, which enables their medication to be more carefully adjusted. "We can see these children's pulmonary function improve with treatment," says Dr. Ducharme. "We are currently studying whether the early and sustained administration of during childhood, the reduction of viral infections, and the control of various environmental factors before and after birth could have an effect on the occurrence, frequency or persistence of until adulthood. These studies will also look at the financial impact of these interventions on health care costs."

Explore further: Review examines diagnosis, management of preschool wheeze

More information: "Diagnosis, management, and prognosis of preschool wheeze." Prof Francine M Ducharme MD,Sze M Tse MD,Bhupendrasinh Chauhan PhD. The Lancet - 3 May 2014 ( Vol. 383, Issue 9928, Pages 1593-1604 ) DOI: 10.1016/S0140-6736(14)60615-2

Related Stories

Review examines diagnosis, management of preschool wheeze

May 5, 2014
(HealthDay)—Preschool children have high asthma morbidity, and further research on the short- and long-term outcomes is needed, according to a review published online May 3 in The Lancet. This review is part of a series ...

Overweight linked with reduced lung function in children with a history of early childhood wheezing

January 2, 2014
Overweight and obesity are significant risk factors for reduced lung function in school-aged children with a history of early childhood wheezing, according to a study carried out at the University of Eastern Finland. The ...

Viral infections in infancy are not associated with wheezing symptoms in later childhood

May 23, 2012
The number of viral infections during infancy is not associated with wheezing later in childhood, according to a new study from researchers in the Netherlands. While viral illnesses with wheezing in infancy predicted wheezing ...

Pre-term birth and asthma: Preterm birth may increase the risk of asthma and wheezing disorders during childhood

March 7, 2014
Researchers at Brigham and Women's Hospital (BWH) in Boston, Massachusetts, in collaboration with investigators at the Maastricht University Medical Centre and Maastricht University School of Public Health in the Netherlands ...

Preterm birth is associated with increased risk of asthma and wheezing disorders

January 28, 2014
Children who are born preterm have an increased risk developing asthma and wheezing disorders during childhood according to new research published in PLOS Medicine.

Recommended for you

Phase 3 trial confirms superiority of tocilizumab to steroids for giant cell arteritis

July 26, 2017
A phase 3 clinical trial has confirmed that regular treatment with tocilizumab, an inhibitor of interleukin-6, successfully reduced both symptoms of and the need for high-dose steroid treatment for giant cell arteritis, the ...

A large-scale 'germ trap' solution for hospitals

July 26, 2017
When an infectious airborne illness strikes, some hospitals use negative pressure rooms to isolate and treat patients. These rooms use ventilation controls to keep germ-filled air contained rather than letting it circulate ...

Researchers report new system to study chronic hepatitis B

July 25, 2017
Scientists from Princeton University's Department of Molecular Biology have successfully tested a cell-culture system that will allow researchers to perform laboratory-based studies of long-term hepatitis B virus (HBV) infections. ...

Male hepatitis B patients suffer worse liver ailments, regardless of lifestyle

July 25, 2017
Why men with hepatitis B remain more than twice as likely to develop severe liver disease than women remains a mystery, even after a study led by a recent Drexel University graduate took lifestyle choices and environments ...

Mind-body therapies immediately reduce unmanageable pain in hospital patients

July 25, 2017
Mindfulness training and hypnotic suggestion significantly reduced acute pain experienced by hospital patients, according to a new study published in the Journal of General Internal Medicine.

Research examines lung cell turnover as risk factor and target for treatment of influenza pneumonia

July 24, 2017
Influenza is a recurring global health threat that, according to the World Health Organization, is responsible for as many as 500,000 deaths every year, most due to influenza pneumonia, or viral pneumonia. Infection with ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.