Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada.
Miller School of Medicine, University of Miami, Miami, Fla.
J Allergy Clin Immunol. 2022 Jun;149(6):2153-2165. doi: 10.1016/j.jaci.2021.10.039. Epub 2021 Dec 30.
Wheezing in early life is associated with asthma in adulthood; however, the determinants of wheezing trajectories and their associations with asthma and lung function in childhood remain poorly understood.
In the CHILD Cohort Study, we aimed to identify wheezing trajectories and examine the associations between these trajectories, risk factors, and clinical outcomes at age 5 years.
Wheeze data were collected at 8 time points from 3 months to 5 years of age. We used group-based trajectory models to derive wheeze trajectories among 3154 children. Associations with risk factors and clinical outcomes were analyzed by weighted regression models.
We identified 4 trajectories: a never/infrequent trajectory, transient wheeze, intermediate-onset (preschool) wheeze, and persistent wheeze. Higher body mass index was a common risk factor for all wheeze trajectories compared with that in the never/infrequent group. The unique predictors for specific wheeze trajectories included male sex, lower respiratory tract infections, and day care attendance for transient wheeze; paternal history of asthma, atopic sensitization, and child genetic risk score of asthma for intermediate wheeze; and maternal asthma for persistent wheeze. Blood eosinophil counts were higher in children with the intermediate wheeze trajectory than in those children with the other trajectories at the ages of 1 and 5 years. All wheeze trajectories were associated with decreased lung function and increased risk of asthma at age 5 years.
We identified 4 distinct trajectories in children from 3 months to 5 years of age, reflecting different phenotypes of early childhood wheeze. These trajectories were characterized by different biologic and physiologic traits and risk factors.
儿童早期的喘息与成年期哮喘相关；然而，喘息轨迹的决定因素及其与儿童期哮喘和肺功能的关系仍知之甚少。
在儿童队列研究中，我们旨在确定喘息轨迹，并研究这些轨迹与 5 岁时的这些轨迹、危险因素和临床结局之间的关系。
喘息数据在 3 个月至 5 岁时采集了 8 次。我们使用基于群组的轨迹模型来确定 3154 名儿童的喘息轨迹。使用加权回归模型分析与危险因素和临床结局的关联。
我们确定了 4 种轨迹：从不/很少喘息轨迹、一过性喘息、学龄前中期（早发）喘息和持续喘息。与从不/很少喘息组相比，较高的体重指数是所有喘息轨迹的共同危险因素。特定喘息轨迹的独特预测因素包括男性、下呼吸道感染和日托中心喘息（一过性喘息）；父亲哮喘史、特应性致敏和哮喘儿童遗传风险评分（中间喘息）；以及母亲哮喘（持续性喘息）。在 1 岁和 5 岁时，具有中间喘息轨迹的儿童的血液嗜酸性粒细胞计数高于其他轨迹的儿童。所有喘息轨迹均与 5 岁时肺功能下降和哮喘风险增加相关。
我们在 3 个月至 5 岁的儿童中确定了 4 种不同的轨迹，反映了儿童早期喘息的不同表型。这些轨迹的特点是不同的生物学和生理学特征以及危险因素。
