Ana Carolina Dela Bianca

Treatment of wheezing in Brazilian infants in the first year of life

To the Editor, Wheezing disorders in infants are a significant global public health problem, with high morbidity (1), and are responsible for overuse of health resources. The first year of life is when the majority of wheezing infants present their first wheezing episode (2). However, it is difficult to distinguish the different wheezing phenotypes in this age group, such as post-viral wheezing and asthma, which delays the use of appropriate treatment. Asthma-like symptoms are particularly common in the first years of life but represent heterogenic diseases, with little to differentiate the clinical presentations. This heterogeneity is the main problem in both research and daily clinical practice and results in inappropriate treatments in young children (3). The Estudio Internacional de Sibilancias en Lactentes (EISL), or International Study of Wheezing in Infants, held in Latin America, the Netherlands, and Spain, was developed in order to study the impact of wheezing in infants in the first year of life and to identify its prevalence and associated risk factors (1). Parents of infants aged between 12 and 15 months, who attended health centers for routine visits or immunization, answered the validated written questionnaire (WQ)(4) on demographic characteristics, respiratory symptoms (including wheezing), use of medications, medical diagnosis, and possible risk factors for wheezing in the first year of life, such as gender; history of previous respiratory infections; parents or siblings with asthma, rhinitis, or eczema; daycare attendance; exposure to tobacco smoke; presence of pets, carpet, or mold at home; skin allergies; breastfeeding; consumption of processed food. In Brazil, seven centers participated in this study, and the prevalence of wheezing ranged from 43 to 63.6% and recurrent wheezing (three or more episodes in the first year of life) ranged from 21.9 to 36.3% between them (1). The aim of this study was to evaluate the use of drugs for the treatment of occasional and recurrent wheezing among Brazilian centers of EISL.

Risk factors for recurrent wheezing in infants: a case-control study

ABSTRACT OBJECTIVE To evaluate the association between recurrent wheezing and atopy, the Asthma Predictive Index, exposure to risk factors, and total serum IgE levels as potential factors to predict recurrent wheezing. METHODS A case-control study with infants aged 6-24 months treated at a specialized outpatient clinic from November 2011 to March 2013. Evaluations included sensitivity to inhalant and food antigens, positive Asthma Predictive Index, and other risk factors for recurrent wheezing (smoking during pregnancy, presence of indoor smoke, viral infections, and total serum IgE levels). RESULTS We evaluated 113 children: 65 infants with recurrent wheezing (63.0% male) with a mean age of 14.8 (SD = 5.2) months and 48 healthy infants (44.0% male) with a mean age of 15.2 (SD = 5.1) months. In the multiple analysis model, antigen sensitivity (OR = 12.45; 95%CI 1.28–19.11), positive Asthma Predictive Index (OR = 5.57; 95%CI 2.23–7.96), and exposure to environmental smoke (OR = 2.63; 95%CI 1.09–6.30) remained as risk factors for wheezing. Eosinophilia ≥ 4.0% e total IgE ≥ 100 UI/mL were more prevalent in the wheezing group, but failed to remain in the model. Smoking during pregnancy was identified in a small number of mothers, and secondhand smoke at home was higher in the control group. CONCLUSIONS Presence of atopy, positive Asthma Predictive Index and exposure to environmental smoke are associated to recurrent wheezing. Identifying these factors enables the adoption of preventive measures, especially for children susceptible to persistent wheezing and future asthma onset.

Associação entre o ganho de peso e a prevalência e gravidade de sibilância e asma no primeiro ano de vida

RESUMO Objective: To evaluate the relationship between different patterns of weight gain in the first year of life and the prevalence and severity of wheezing and asthma in infants. Methods: Responses of 9,159 parents to the questionnaire of the Estudio Internacional de Sibilancias en Lactantes (EISL, International Study of Wheezing in Infants) were analyzed. Families lived in the cities of Sao Paulo, Recife, Cuiaba, and Belem. Reported weight at birth and at one year were converted to z scores (z). Rapid weight gain was defined as a difference in weight greater than 0.67z, and excessive weight gain, greater than 2.01z. Results: Rapid weight gain was observed in 55.7% of the infants, and excessive weight gain in 20.8%. Infants with rapid weight gain showed a significantly higher prevalence of recurrent wheezing (18.9% vs. 18.2%) and hospitalization for wheezing (8.9% vs. 7.5%). Infants with excessive weight gain had a significantly higher prevalence of hospitalization for wheezing (10.1% vs. 7.8%) and medical diagnosis of asthma (8.7% vs. 7.3%). Breastfeeding for at least six months was significantly less frequent among infants with rapid weight gain (45.2% vs. 51.4%). Conclusions: The majority of the infants evaluated showed weight gain above the expected in the first year of life. Rapid weight gain and excessive weight gain in the first year of life were significantly associated with more severe patterns of wheezing in infancy, and excessive weight gain was also associated with a medical diagnosis of asthma, regardless of the presence of breastfeeding.