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Published ahead of print on August 18, 2005, doi:10.1164/rccm.200504-525OC
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American Journal of Respiratory and Critical Care Medicine Vol 172. pp. 1253-1258, (2005)
© 2005 American Thoracic Society
doi: 10.1164/rccm.200504-525OC

Original Article

Outcome of Asthma and Wheezing in the First 6 Years of Life

Follow-up through Adolescence

Wayne J. Morgan*, Debra A. Stern*, Duane L. Sherrill, Stefano Guerra, Catharine J. Holberg, Theresa W. Guilbert, Lynn M. Taussig, Anne L. Wright and Fernando D. Martinez

Arizona Respiratory Center and Department of Pediatrics, University of Arizona Health Sciences Center, Tucson, Arizona; and National Jewish Medical and Research Center and University of Colorado Health Sciences Center, Denver, Colorado

Correspondence and requests for reprints should be addressed to Fernando D. Martinez, M.D., Arizona Respiratory Center, P.O. Box 245030, Tucson, AZ 85724. 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 3 yr and active wheeze at age 6 yr: never wheezers (n = 425), transient early wheezers (n = 164), persistent wheezers (n = 113), and late-onset wheezers (n = 124).

Objective: We sought 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 was measured by conventional spirometry, and atopy was determined by skin prick tests.

Results: The prevalence of atopy and wheeze by age 16 yr 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 (–259 ml/s, p < 0.001, and –260 ml/s, p = 0.001, respectively), FEV1 (–75 ml, p = 0.02, and –87 ml, p = 0.03, respectively), and FEV1:FVC ratio (–1.9%, p = 0.002, and –2.5%, p = 0.001, respectively) through age 16 yr compared with never wheezers. Late-onset wheezers had levels of lung function similar to those of never wheezers through age 16 yr. There was no significant change in lung function among subjects with any of the four phenotypes, relative to their peers, from age 6 to 16 yr.

Conclusion: Patterns of wheezing prevalence and levels of lung function are established by age 6 yr and do not appear to change significantly by age 16 yr in children who start having asthmalike symptoms during the preschool years.

Key Words: adolescent • preschool child • respiratory function tests




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