Published ahead of print on November 19, 2004, doi:10.1164/rccm.200406-791OC Am. J. Respir. Crit. Care Med., Volume 171, Number 4, February 2005, 323-327 A more recent version of this article appeared on February 15, 2005
Submitted on June 23, 2004 Behavior Problems Antecede the Development of Wheeze in Childhood: a Birth Cohort StudyRachel Calam1*,1 Academic Division of Clinical Psychology, Education and Research Centre, Wythenshawe Hospital, University of Manchester, Manchester, United Kingdom, 2 North West Lung Centre, Academic Division fo Medicine and Surgery South, Wythenshawe Hospital, University of Manchester, Manchester, United Kingdom * To whom correspondence should be addressed. E-mail: rachel.calam{at}man.ac.uk.
Rationale: It is not clear to what extent behavior problems observed in children with asthma antecede asthma development, or are a consequence of the disease. Objectives: We investigated psychological factors at age 3 years and subsequent development of wheeze by age 5 in an unselected birth cohort study. Children were recruited prenatally, followed prospectively and reviewed at age 3 and 5 years. Measurements and Main Results: The rate of significant behavior problems at age 3 years (above clinically relevant cut-off on Eyberg Child Behavior Inventory) was compared between children who had never wheezed (n=397) and those developing late-onset wheezing (after age 3 years; n=39). Late-onset wheezers were more likely to be above cut-offs for behavior problems at 3 years (before wheeze onset) compared to children who never wheezed, on Intensity (23.1% vs. 6.0%, p<0.001) and Problem scores (10.8% vs. 1.3%, p<0.001). Families of late-onset wheezers had poorer scores on family functioning variables, but we found no evidence of increased anxiety or depression scores in parents. In the multivariate analysis, significant and independent associates of late-onset wheeze were: maternal asthma (odds ratio 5.4, 95% confidence intervals 2.1-13.8, p<0.001), maternal smoking when child was aged 3 years (3.3, 1.2-8.7, p=0.02), expressiveness (0.71, 0.55-0.9, p=0.005) and significant behavior problems at age 3 years (3.5, 1.2-9.9, p=0.02). Conclusions: Behavior problems in early life are associated with increased risk of subsequent development of wheeze. Key words: behavior problems; wheeze; asthma; child
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