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Asthma is a syndrome of reversible bronchial obstruction in hyperresponsive airways mediated by allergy or other trigger factors. Allergic disease represents true asthma while transient wheezing may be caused by factors such as viral infection, aspiration, prematurity and neonatal lung damage and is likely to outgrow within few years. Personal or family history of atopy, increased serum IgE and positive skin tests may suggest allergic asthma, which persists throughout life irrespective of presence or absence of symptoms. Onset of age beyond 2 years, severity, persistence or recurrence of symptoms beyond 6 years of age, airway hyperresponsiveness and abnormal lung function even in absence of symptoms, strong family history especially in the mother, exposure to allergens, parental smoking and delay in starting appropriate therapy are some of high risk factors in persistence of asthma in adult life. As outcome of asthma depend upon multiple variable factors, it is difficult to predict natural history of asthma in an individual child.
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PMID:Natural history of asthma in children. 1198 Apr 66

The relative influence of early life events in the development of IgE-mediated allergy is still undetermined. We investigated early life factors in relation to skin-prick test positivity (SPT) and clinical manifestations of atopic disease in a population-based sample of 201 Italian children (3 months-5 years), after considering their interactions with known determinants of allergy. Among them, 143 children had SPT performed to common allergens. Threatened abortions, general anesthesia at delivery, prematurity, birthweight < 2500 g, maternal smoking, dampness and gas heating exposure were all significantly related to an increased risk of frequent rhinitis in the absence of cold (18%). In utero smoking, threatened abortions, fetal health complications, infantile colic, maternal smoking in childhood (satisfactorily correlated with maternal expired CO during the survey) and respiratory infections were all independent determinants of frequent wheezing (23%). Doctor's diagnosis of asthma (3%) was related to in utero smoking, being born in spring, infantile colic and respiratory infections. A simultaneous exposure to in utero smoking and infantile colic put the infants to a fourfold higher risk of frequent wheezing and to a ninefold risk of asthma, respectively. Having a pet and washing blankets at < 60 degrees C were inversely related to frequent wheezing. Data confirmed also that maternal phenotype influences the inheritance of atopic disease. No event, except a low intake of fruit (< 3/week), was significantly associated with positive SPT (20%) or eczema. Besides allergic sensitization, other events, which occur early in life, seem critical to the development of IgE-mediated allergy.
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PMID:Early life factors related to clinical manifestations of atopic disease but not to skin-prick test positivity in young children. 1200 Apr 82

Respiratory syncytial virus (RSV) is the most important cause of lower respiratory tract infection in infants and young children. Around 20 000 RSV-infected infants require hospitalization in the UK during each yearly epidemic, which is about 3% of the birth cohort. Most children are infected by 2 years of age. Risk factors for severe disease include young infants, prematurity, chronic lung and cardiac conditions or immunodeficiency. Humoral immunity is incomplete and short-lived, yet reinfections cause less severe disease. RSV infects infants despite the presence of specific neutralizing antibodies. RSV infection can be linked to the development of individual wheezing episodes. A competent cellular immune system is necessary to reduce disease severity. RSV infection provokes an RSV-specific T-lymphocyte response with the release of cytokines. There is a delicate balance between the protective and disease-enhancing effects of the host's immune response to RSV infection.
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PMID:Basic epidemiology and immunopathology of RSV in children. 1253 Oct 81

There is convincing evidence that several distinct wheezing syndromes exist in childhood. The purpose of this research was to assess the potential of using healthcare utilization profiles to identify wheezing syndromes in children which are distinct from asthma. Using population-based healthcare administrative data, a cohort of children, aged 5-15 years, with bronchitis diagnoses from time of birth to 1995, but no physician diagnoses of asthma, was followed over the period January 1996-March 1998. In this follow-up period, 13% had subsequent healthcare utilization for asthma, 23% had continued healthcare utilization for bronchitis, and 64% had no further healthcare utilization. The likelihood of bronchitis vs. asthma outcomes was determined for a variety of asthma risk factors. In a cohort of 11,043 children with initial healthcare contact for bronchitis but not asthma, two potentially distinct entities of bronchitis emerged from our data: 1) transient bronchitis, similar to transient wheezing of early childhood, which was associated with winter-only healthcare utilization and absence of allergy, and 2) recurrent bronchitis which differed from asthma on the basis of winter-only healthcare utilization, prematurity at birth, absence of allergy, and low socioeconomic status. Healthcare administrative records can be used to describe the natural history of wheezing in children and to identify markers which may discriminate asthma from other syndromes.
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PMID:Childhood wheezing syndromes and healthcare data. 1283 92

An unmatched, hospital-based case-control study was performed, to determine, whether respiratory syncytial virus (RSV) etiology in hospitalized young children can be predicted clinically. Children under 2 years of age admitted with a lower respiratory tract infection in three hospitals in northern Germany were included (one tertiary and two secondary centers). Cases were children tested positive for RSV by multiplex RT-PCR. One control group consisted of children tested negative for RSV in the multiplex-RT-PCR and a second control group consisted of patients in whom no PCR was done. A weighted backward stepwise logistic regression model was applied for multivariate analysis. RSV-etiology could be predicted with a sensitivity of 72.8% and a specificity of 73.2%. Young age, disease entity--pneumonia or bronchiolitis, center, intercostal retractions, absence of an underlying condition, low level of C-reactive protein, short duration of symptoms (all on admission), prematurity and epidemiologic year were predictive; anatomical infiltrates and wheezing were not. Pathogen specific diagnosis is necessary for individual therapy, allocation in observational studies or treatment trials and for surveillance of airway infections in children, since the positive predictive value is too low for an accurate diagnosis and decision making. Multivariate techniques are effective tools in complex clinical research for deconfounding.
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PMID:Can respiratory syncytial virus etiology be diagnosed clinically? A hospital-based case-control study in children under two years of age. 1288 90

The aim of the present study was to analyse the clinical and epidemiological characteristics of bronchiolitis caused by respiratory syncytial virus (RSV) in 225 children observed in a paediatric hospital in Lisbon, Portugal, and to determine the clinical, epidemiological, or laboratory parameters that correlate with greater severity of the disease. This prospective study included hospitalised and ambulatory children younger than 36 months of age with a diagnosis of bronchiolitis and was conducted during two consecutive RSV epidemiological seasons (November-March 2000/01 and 2001/02). The median age of the patients was 5 months, and the male-to-female ratio was 1.6:1. RSV was isolated in 60.9% of patients, predominantly in the hospitalised group. The subtype A:B ratio was 7.4:1 and was similar in both seasons. RSV-positive patients were younger, had more severe clinical forms of bronchiolitis, and fewer changes in leucocyte total and differential counts. Among infected patients, higher clinical severity scores occurred in association with first wheezing episodes, overcrowded households, attendance at day-care centres, or prematurity (<36 weeks). This first prospective study of RSV epidemiology in Portugal provides a foundation for appropriate surveillance programmes of RSV infection in this country. A multicentre study is desirable in order to delineate optimal prophylactic and therapeutic guidelines for RSV infection in Portugal.
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PMID:Bronchiolitis caused by respiratory syncytial virus in an area of portugal: epidemiology, clinical features, and risk factors. 1461 37

The purpose of this study was to examine lung function and bronchodilator responsiveness in infants with a history of prematurity and bronchopulmonary dysplasia (BPD), using the raised volume rapid thoracoabdominal compression technique as well as with whole-body plethysmography. Spirometric measurements were obtained in 28 infants with a history of BPD, defined as preterm birth with O2 requirement at 36 weeks postmenstrual age (gestational age at birth, 26.4 +/- 2.1 weeks, mean +/- SD; birthweight, 898 +/- 353 g; age at study, 68.0 +/- 35.6 weeks). Fractional lung volumes were measured in 27 subjects. Values were expressed as percentage of predicted normal values. Compared to normal infants, those with a history of BPD exhibited decreases in forced expiratory flows including forced expiratory volume in 0.5 sec (76.3 +/- 19.6%), forced expiratory flow at 75% of expired forced vital capacity (FEF75; 59.5 +/- 30.7%), and FEF(25-75) (74.0 +/- 26.8%; P<0.01 for all). Functional residual capacity (107.9 +/- 25.3%), residual volume (RV, 124.5 +/- 42.7%), and RV/total lung capacity (RV/TLC, 128.2 +/- 35.3%) were increased in infants with a history of BPD (P<0.05 for each). There was no difference in TLC between groups. Seventeen infants were studied both pre- and postalbuterol, and 6 (35%) demonstrated significant bronchodilator responsiveness. Infants with recurrent wheezing showed greater expiratory flow limitation, hyperinflation, and airways responsiveness, whereas those without wheezing showed only modest airway dysfunction. We conclude that infants with a history of BPD have pulmonary function abnormalities characterized by mild to moderate airflow obstruction and air trapping.
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PMID:Pulmonary function in bronchopulmonary dysplasia. 1496 17

Many adult diseases have their roots in infancy or even prenatally. If events that initiate these diseases, as opposed to those that propagate the disease state, are to be understood, then the difficult area of how ethically to research problems in infancy must be tackled. Furthermore, the predisposition to archetypally 'pure' adult problems such as chronic obstructive pulmonary disease, may lie antenatally, the effects being masked until the lung starts to age. An additional factor is that the success of paediatricians, for example in ensuring the survival of extremely premature, low birth weight infants leads to adult survivors with potentially a whole new morbidity. The first prerequisite to making progress is a sound understanding of the development of the normal lung and how adverse environmental and genetic influences, such as exposure to environmental tobacco smoke and maternal atopy, respectively, may affect growth. This paper focuses on three key areas: the implications of different pre-school wheezing phenotypes for adult disease; the importance of very early life events in cystic fibrosis; and the long term consequences of chronic lung disease of prematurity. Finally, the ethical principles that must underpin future research in pre-school children is discussed, as well as the means we might use to further our understanding of the relevant early disease processes.
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PMID:Asthma research: the real action is in children. 1591 55

In recent years some studies have focused attention on the contribution of early life risk factors in the pathogenesis of asthma and wheezing. In our study we tested the hypothesis that wheezing in childhood is not a single disorder and that different wheezing phenotypes (called transient early wheezing, persistent wheezing and late-onset wheezing) are associated with different risk factors. We evaluated the association between pre, perinatal and early life (1st year) risk factors and different wheezing phenotypes in children 6-7 years old enrolled in the SIDRIA-2 project. Maternal smoking in pregnancy is associated with early and persistent wheezing; prematurity, child's admission to hospital shortly after birth for respiratory problems, indicators of respiratory infections during the child's first year of life are associated with early wheezing. An increase in childhood infections from contact with siblings or day care attendance is a risk factor for early wheezing but protective against late-onset wheezing, while an opposite pattern was observed for breastfeeding. Finally, mould or dampness in the child's bedroom during his first year of life is associated with all wheezing phenotypes. The risk factors studied are differently associated with different wheezing phenotypes.
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PMID:[Risk factors in the pre-, perinatal and early life (first year) for wheezing in young children]. 1612 54

The aim of this study was to examine a possible association between birth season (date of birth) and future development of asthma in children. A case-control study was designed to include asthmatic children aged 2-7 years, living in the city of Beer-Sheva, in southern Israel, registered in one pediatric center. Controls were healthy children matched for age and registered at the same clinic. Demographic data, past medical history, and asthma history and severity were collected using the computerized medical charts and asthma registry. A structured telephone questionnaire was used to complete the data. Children with a history of prematurity or chronic significant illness were excluded from the study. Sixty-six children and 69 controls were enrolled in the study. There were significantly more males in the asthmatic group compared to controls (P = 0.003). History of bronchiolitis or recurrent wheezing episodes in the first year, family history of asthma, and Middle-Eastern origin were significantly more common among asthmatic children than controls (P < 0.001). Asthmatic children were more likely to be born between March and June and least likely to be born between October and December, compared to controls (P < 0.05). Multivariate logistic regression analysis revealed three variables to be independent significant risk factors for development of asthma: birth season between March and June, acute bronchiolitis or recurrent wheezing episodes during first year of life, and male gender. Birth season during late winter and spring is associated with asthma during childhood.
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PMID:The association between birth season and future development of childhood asthma. 1742 Oct 38


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