Early childhood respiratory symptoms and the subsequent diagnosis of asthma,☆☆,,★★

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Abstract

Background: Respiratory symptoms are frequent in very young children, and the relation of these symptoms to later asthma in some of these children is unknown. Objective: The aim of the study was to describe the natural history of respiratory symptoms in a community-based sample of young children who were prospectively observed for as long as 11 years. Methods: Subjects were participants in the Tucson Epidemiologic Study of Airways Obstructive Disease. They were under 5 years of age at enrollment and were studied by means of a parent-administered mail survey instrument every 1 to 2 years for 3 to 11 years. Results: Among subjects younger than 1 year of age, no single respiratory symptom, such as cough or wheeze only with colds, significantly increased the risk of a subsequent diagnosis of asthma. Among 1- and 2-year-olds, however, those with wheeze only with colds and those with attacks of shortness of breath with wheeze were more likely to be diagnosed with asthma later when compared with children without those symptoms (odds ratio = 2.1; p < 0.05 for wheeze only with colds). At ages 3 to 4 years, symptoms were even more strongly associated with subsequent asthma (odds ratio = 7.2; p < 0.0001 for attacks of shortness of breath with wheeze). Conclusion: Although respiratory symptoms reported by parents very early in life are not significantly associated with future asthma, those symptoms that begin at or persist through ages 3 to 4 years are. (J ALLERGY CLIN IMMUNOL 1996;98:48-54.)

Section snippets

METHODS

Subjects are participants in the Tucson Epidemiologic Study of Airways Obstructive Disease, a longitudinal study of a representative sample of white, non-Mexican-American households in Tucson, Arizona. Methods of selection of the overall population sample have been reported in detail.6 Briefly, the sample consists of a random cluster sample of households in the city in 1971 and 1972, stratified on the basis of age of head of household and socioeconomic status. Over the years, we have continued

RESULTS

In Table II we have shown the prevalence of asthma in subjects between ages 1 and 11 years, grouped by their lower respiratory tract symptoms before the age of 1 year. We have included the 38 subjects who were diagnosed with asthma between the ages of 1 and 5 years, but we did exclude the one subject who was diagnosed before the age of 1 year. No single symptom, such as wheeze even without colds, in two-way comparisons with children without that symptom, significantly increased the risk of a

DISCUSSION

This report is one of several prospective studies that we have published on Tucson subjects who were subsequently diagnosed with asthma.9, 10, 11 In all of these reports, which separately examined subjects aged 10 to 19, 20 to 40, and over 60 years, asthma was frequently preceded by lower respiratory tract symptoms, sometimes for years. Among subjects who were diagnosed with asthma after age 60, for example, one third reported respiratory symptoms before age 16.11 Similarly, here we report that

Acknowledgements

We thank the subjects and their parents for their continuing commitment to the Tucson Study.

References (19)

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From the Respiratory Sciences Center, University of Arizona College of Medicine, Tucson.

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Supported by a National Heart, Lung, and Blood Institute Specialized Center of Research grant (HL-14135).

Reprint requests: Russell Dodge, MD, Respiratory Sciences Center, Tucson, AZ 85724.

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