Recurrent Wheezing and Progression to Childhood Asthma

By Patrick Zakka, MD - April 4, 2023

In a recent report, published in The Journal of Allergy and Clinical Immunology, researchers evaluated 3 recurrent wheezing phenotypes for links to development of childhood asthma among infants hospitalized with bronchiolitis.

According to the study’s lead author, Jonathan Mansbach, most infants with severe bronchiolitis developed recurrent wheezing, as defined by National Heart, Lung, and Blood Institute (NHLBI) 2020 criteria. Furthermore, based on NHLBI phenotypes, 33-54% of patients developed asthma by 6 years of age.

Recurrent Wheezing Associated With Childhood Asthma

The investigators assessed 921 infants with bronchiolitis from 17 medical centers using NHLBI 2020 definitions for recurrent wheezing and 2 additional phenotypes, multitrigger and severe. A sensitivity analysis using the NHLBI 2007 criteria was also performed. A multivariable logistic regression model was used to identify the phenotype with the highest risk.

According to the study, 632 (69%), 734 (80%), and 165 (18%) of 921 infants developed recurrent wheezing, multitrigger wheezing, and severe wheezing per NHLBI 2020 criteria by 4 years of age. The authors noted 296 (32%) infants met the NHLBI 2007 criteria for recurrent wheezing by age 3.

A total of 862 (94%) infants had evaluable childhood data, of which 239 (28%) developed asthma by the age of 6 years. The incidence of progression to childhood asthma by phenotype was as follows:

  • NHLBI 2020 Recurrent Wheezing: 33%
  • Multitrigger Wheezing: 33%
  • Severe Wheezing: 54%
  • NHLBI 2007 Recurrent Wheezing: 52%

After evaluation, analysts identified preterm birth, child eczema, maternal asthma, and non-respiratory syncytial virus infection were variables associated with progression from  severe wheezing to asthma.

Considering their results, Mansbach and colleagues wrote that “future research will examine whether earlier treatment of high-risk phenotypes will improve wheezing symptoms and potentially prevent childhood asthma.”

Related: Confirming Validity of the Childhood Asthma Control Test

Latest News

December 1, 2023