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Published ahead of print on August 18, 2005, doi:10.1164/rccm.200504-525OC

Am. J. Respir. Crit. Care Med., Volume 172, Number 10, November 2005, 1253-1258

A more recent version of this article appeared on November 15, 2005
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Submitted on April 4, 2005
Accepted on August 17, 2005

Outcome of Asthma and Wheezing in the First Six Years of Life: Follow-up through Adolescence

Wayne J Morgan1, Debra A Stern2, Duane L Sherrill2, Stefano Guerra2, Catharine J Holberg2, Theresa W Guilbert1, Lynn M Taussig3, Anne L Wright1, and Fernando D Martinez2*

1 Arizona Respiratory Center, University of Arizona, Tucson, Arizona, USA; Department of Pediatrics, University of Arizona, Tucson, Arizona, USA, 2 Arizona Respiratory Center, University of Arizona, Tucson, Arizona, USA, 3 National Jewist Medical and Research Center and University of Colorado Health Sciences Center, Denver, Colorado, USA

* To whom correspondence should be addressed. E-mail: fernando{at}arc.arizona.edu.

Rationale: The effect of early life wheezing on respiratory function and continued symptoms through adolescence has not been fully described. Using data from a population-based birth cohort in Tucson, Arizona, we previously described four phenotypes based on the occurrence of wheezing lower respiratory illnesses before age three and active wheeze at age six: never wheezers (n=425), transient early wheezers (n=164), persistent wheezers (n=113), and late onset wheezers (n=124)1. Objective: To determine the prognosis for these phenotypes with reference to lung function and symptoms through adolescence. Methods: Current wheeze was assessed by questionnaire, lung function measured by conventional spirometry, and atopy determined by skin prick tests. Results: The prevalence of atopy and wheeze by age 16 was similar for never and transient wheezers and for persistent and late onset wheezers. Both transient early and persistent wheezers had significantly lower FEF25-75 (-259ml/s, p<0.001 and -260ml/s, p=0.001, respectively), FEV1 (-75ml, p=0.02, and -87ml, p=0.03, respectively) and FEV1/FVC ratio (-1.9%, p=0.002, and -2.5%, p=0.001, respectively) through age 16 compared to never wheezers. Late onset wheezers had levels of lung function similar to never wheezers through age 16. There was no significant change in the lung function of the four phenotypes, relative to their peers, from age 6 to 16. Conclusion: Patterns of wheezing prevalence and levels of lung function are established by age 6 and do not appear to change significantly by age 16 in children who start having asthma-like symptoms during the preschool years.
Key words: adolescent, preschool child, respiratory function tests




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