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Infants with Flow Limitation at 4 Weeks

Outcome at 6 and 11 Years

University Department of Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia

Correspondence and requests for reprints should be addressed to Peter N. Le Souëf, Ph.D., University Department of Paediatrics, Princess Margaret Hospital for Children, GPO Box D184, Perth, WA, 6001 Australia. E-mail: peterles{at}paed.uwa.edu.au

Within a longitudinal study of lung function in 243 infants, we identified a group of 23 individuals with flow limitation in tidal expiration. In infancy, flow-limited children have reduced lung function and increased airway responsiveness (AR), and at 2 years of age they are diagnosed with asthma more frequently. We hypothesized that these observations would persist throughout childhood. Data from ages 3 to 11 years were analyzed. Only at 4 years of age did the flow-limited group have increased wheeze compared with other cohort members (odds ratio, 4.25; 95% confidence interval [CI], 1.11 to 16.2; p = 0.04; n = 114). At 6 years of age, 117 cohort members were seen. The flow-limited group (n = 14) had greater AR (p = 0.009) and reduced mean FEV₁ (131 ml; 95% CI, 16 to 246; p = 0.03) and FEF_25–75 (0.28 L/second; 95% CI, 0.05 to 0.52; p = 0.02). At 11 years of age, 183 children were seen and the flow-limited group (n = 18) had greater AR (p = 0.02) and a trend toward reduced mean FEF_25–75 (0.24 L/second; 95% CI, -0.02 to 0.49; p = 0.08). Atopy and parental asthma were not increased in the flow-limited group. We suggest that the physiologic abnormality that causes flow limitation in early infancy may identify an at-risk group, different from asthma, who have reduced lung function and increased airway responsiveness in later life.

Key Words: bronchial hyperreactivity • child • longitudinal studies • respiratory function tests

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