SELECTED ARTICLES FROM THE RECENT LITERATURE 2003

12/8/03

Wheezy bronchitis - long-term pulmonary function

Summary
Are children who wheeze during respiratory infection (but not at other times) at risk for pulmonary dysfunction in adulthood? This question has been debated for years with some reports describing no increased risk for asthma later in life. Edwards et al of the Aberdeen Royal Infirmary in Aberdeen, Scotland, UK, reported a long-term follow-up in 2001 of individuals who had been subjects of a survey in 1964 of school children in Aberdeen. In an earlier follow-up of these children in 1989 when the subjects were in their early 30's, those who had previously wheezed only with URI during their childhood had normal lung function in 1989.

In the present follow-up 12 years later, 177 of the original group could be located for examination and pulmonary function measurements. The 46 subjects with a past history of childhood asthma had the highest incidence of current bronchial symptoms, hospitalization for chest problems and significantly lower FEV-1 than those who wheezed previously only with URI in childhood (called wheezy bronchitis by the authors). However, in 2001, those in the wheezy bronchitis in childhood group had markedly lower FEV-1 and more frequent chest disease related hospitalization than the adults who had no previous wheezing at all in childhood. These differences persisted even after adjusting for variables such as smoking history. Furthermore, the annualized rate of decline in FEV-1 from 1989 to 2001 was as great in those with childhood wheezy bronchitis as in those with persistent childhood asthma.

Reference
Chest 2003; 124:18-24

Editor's Comments
The findings in this study were puzzling to me, in that a prominent decrease in FEV-1 was noted in subjects in their 40's after childhood wheezing with URI (but not at other times) when pulmonary function was normal in the same subject group 12 years earlier. One wants to be sure that there was no selection for more symptomatic subjects who could be located in the current (longer) follow-up study. In another recently published follow-up study reviewed in this Current Literature section (BMJ 2003; 326:422-23) only 6% of subjects with past histories of wheezing only with URI in childhood had recent wheezing when they were 42 years old. This contrasted with persistent wheezing at age 42 in 60% of subjects with past histories of severe asthma in childhood. Furthermore, Martinez has reported that the results of his group's follow-up studies of childhood wheezing indicates that most of the subsequent decrease in pulmonary function occurs by the early school years in those with wheezing in early childhood (N Eng J Med 2003;349:1473-75). This finding makes the observation (described above) a decrease in pulmonary function between the 2 follow-up evaluations (1989 and 2001) even more puzzling.

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