BACKGROUND: Young children with wheezing predominantly with respiratory tract illnesses experience severe exacerbations separated by extended periods of wellness and may be described as having "severe intermittent wheezing," a diagnostic category not currently recognized in national guidelines. OBJECTIVE: We sought to characterize a cohort of children with recurrent severe wheezing. METHODS: A total of 238 children 12 to 59 months enrolled in the Acute Intervention Management Strategies trial were characterized through comprehensive allergy, asthma, environmental, and quality of life assessments. RESULTS: Asthma symptoms over the period of the preceding year occurred at frequencies consistent with intermittent asthma, as 94.5% of children experienced activity limitation < or = 2 times per month. However, frequent severe exacerbations were common, because 71% experienced > or = 4 wheezing episodes over the period of the preceding year, 95% made at least 1 primary care visit, 52% missed school or daycare, 40% made an emergency department visit, and 8% were hospitalized for wheezing illnesses. Atopic features were common, including eczema (37%), aeroallergen sensitization (46.8%), and positive asthma predictive index (59.7%). Oral corticosteroid use in the previous year (59.7% of the cohort) identified a subgroup with more severe disease documented by a higher incidence of urgent care visits (P = .0048), hospitalizations (P = .0061), aeroallergen sensitization (P = .047), and positive asthma predictive indices (P = .007). CONCLUSION: Among preschool children enrolled in the Acute Intervention Management Strategies trial, a subgroup was identified with severe intermittent wheezing characterized by atopic features and substantial illness-related symptom burden despite prolonged periods of wellness. CLINICAL IMPLICATIONS: Preschool children with recurrent severe wheezing episodes experience significant illness-related morbidity and exhibit features of atopic predisposition.
BACKGROUND: Young children with wheezing predominantly with respiratory tract illnesses experience severe exacerbations separated by extended periods of wellness and may be described as having "severe intermittent wheezing," a diagnostic category not currently recognized in national guidelines. OBJECTIVE: We sought to characterize a cohort of children with recurrent severe wheezing. METHODS: A total of 238 children 12 to 59 months enrolled in the Acute Intervention Management Strategies trial were characterized through comprehensive allergy, asthma, environmental, and quality of life assessments. RESULTS: Asthma symptoms over the period of the preceding year occurred at frequencies consistent with intermittent asthma, as 94.5% of children experienced activity limitation < or = 2 times per month. However, frequent severe exacerbations were common, because 71% experienced > or = 4 wheezing episodes over the period of the preceding year, 95% made at least 1 primary care visit, 52% missed school or daycare, 40% made an emergency department visit, and 8% were hospitalized for wheezing illnesses. Atopic features were common, including eczema (37%), aeroallergen sensitization (46.8%), and positive asthma predictive index (59.7%). Oral corticosteroid use in the previous year (59.7% of the cohort) identified a subgroup with more severe disease documented by a higher incidence of urgent care visits (P = .0048), hospitalizations (P = .0061), aeroallergen sensitization (P = .047), and positive asthma predictive indices (P = .007). CONCLUSION: Among preschool children enrolled in the Acute Intervention Management Strategies trial, a subgroup was identified with severe intermittent wheezing characterized by atopic features and substantial illness-related symptom burden despite prolonged periods of wellness. CLINICAL IMPLICATIONS: Preschool children with recurrent severe wheezing episodes experience significant illness-related morbidity and exhibit features of atopic predisposition.
Authors: Katherine Rivera-Spoljaric; Vernon M Chinchilli; Lindsay J Camera; Robert S Zeiger; Ian M Paul; Brenda R Phillips; Lynn M Taussig; Robert C Strunk; Leonard B Bacharier Journal: J Pediatr Date: 2009-03-25 Impact factor: 4.406
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Authors: Robert S Zeiger; David Mauger; Leonard B Bacharier; Theresa W Guilbert; Fernando D Martinez; Robert F Lemanske; Robert C Strunk; Ronina Covar; Stanley J Szefler; Susan Boehmer; Daniel J Jackson; Christine A Sorkness; James E Gern; H William Kelly; Noah J Friedman; Michael H Mellon; Michael Schatz; Wayne J Morgan; Vernon M Chinchilli; Hengameh H Raissy; Elizabeth Bade; Jonathan Malka-Rais; Avraham Beigelman; Lynn M Taussig Journal: N Engl J Med Date: 2011-11-24 Impact factor: 91.245
Authors: Avraham Beigelman; Tonya S King; David Mauger; Robert S Zeiger; Robert C Strunk; H William Kelly; Fernando D Martinez; Robert F Lemanske; Katherine Rivera-Spoljaric; Daniel J Jackson; Theresa Guilbert; Ronina Covar; Leonard B Bacharier Journal: J Allergy Clin Immunol Date: 2013-03-14 Impact factor: 10.793
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