Asthma and Wheezing in the First Six Years of Life

doi:10.1056/NEJM199501193320301

Volume 332:133-138		January 19, 1995		Number 3

Asthma and Wheezing in the First Six Years of Life

Fernando D. Martinez, Anne L. Wright, Lynn M. Taussig, Catharine J. Holberg, Marilyn Halonen, Wayne J. Morgan, for The Group Health Medical Associates

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ABSTRACT

Background Many young children wheeze during viral respiratoryinfections, but the pathogenesis of these episodes and theirrelation to the development of asthma later in life are notwell understood.

Methods In a prospective study, we investigated the factorsaffecting wheezing before the age of three years and their relationto wheezing at six years of age. Of 1246 newborns in the Tucson,Arizona, area enrolled between May 1980 and October 1984, follow-updata at both three and six years of age were available for 826.For these children, assessments in infancy included measurementof cord-serum IgE levels (measured in 750 children), pulmonary-functiontesting before any lower respiratory tract illness had occurred(125), measurement of serum IgE levels at nine months of age(672), and questionnaires completed by the children's parentswhen the children were one year old (800). Assessments at sixyears of age included measurement of serum IgE levels (in 460),pulmonary-function testing (526), and skin allergy testing (629).

Results At the age of six years, 425 children (51.5 percent)had never wheezed, 164 (19.9 percent) had had at least one lowerrespiratory tract illness with wheezing during the first threeyears of life but had no wheezing at six years of age, 124 (15.0percent) had no wheezing before the age of three years but hadwheezing at the age of six years, and 113 (13.7 percent) hadwheezing both before three years of age and at six years ofage. The children who had wheezing before three years of agebut not at the age of six had diminished airway function (length-adjustedmaximal expiratory flow at functional residual capacity [V_submaxFRC]) both before the age of one year and at the age of sixyears, were more likely than the other children to have motherswho smoked but not mothers with asthma, and did not have elevatedserum IgE levels or skin-test reactivity. Children who startedwheezing in early life and continued to wheeze at the age ofsix were more likely than the children who never wheezed tohave mothers with a history of asthma (P<0.001), to haveelevated serum IgE levels (P<0.01) and normal lung functionin the first year of life, and to have elevated serum IgE levels(P<0.001) and diminished values for V_maxFRC (P<0.01) atsix years of age.

Conclusions The majority of infants with wheezing have transientconditions associated with diminished airway function at birthand do not have increased risks of asthma or allergies laterin life. In a substantial minority of infants, however, wheezingepisodes are probably related to a predisposition to asthma.

Source Information

From the Respiratory Sciences Center (F.D.M., A.L.W., L.M.T., C.J.H., M.H., W.J.M.) and the Department of Pediatrics (F.D.M., A.L.W., L.M.T., W.J.M.), University of Arizona College of Medicine, Tucson.

The members of the Group Health Medical Associates were John Bean, M.D., Henry Bianchi, M.D., John Curtiss, M.D., John Ey, M.D., Alejandro Sanguineti, M.D., Barbara Smith, M.D., Terry Vondrak, M.D., Neil West, M.D., and Maureen McLellan, R.N., P.N.P.

Address reprint requests to Dr. Martinez at the Respiratory Sciences Center, Arizona Health Sciences Center, 1501 N. Campbell Ave., Tucson, AZ 85724.

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