RECURRENT WHEEZING IN INFANTS AND PRESCHOOL CHILDREN – RISK FACTORS THAT INFLUENCE THE SEVERITY OF ACUTE EPISODES

Abstract

Introduction. Recurrent wheezing represents a very common condition in the age group of 0-6 years. Several risk factors are associated with it, both genetic factors prenatal or postnatal environmental factors. It is important to evaluate to what extent these factors are involved in the occurrence of recurrent wheezing, but also how they influence the evolution of the disease. Objective. The objective of the study was to evaluate the risk factors that influence the severity of acute wheezing episodes in children with recurrent wheezing. Material and method. We conducted an observational prospective study that included 40 children aged 0-6 years with history of 3 or more wheezing episodes to demonstrate the existence of some epidemiological associations between certain risk factors and recurrent wheezing. Results. The average age was approximately 22 months, the minimum age being 3 months, and the maximum age of 67 months. Of the 40 patients, 42.5% (n = 17) experienced signs of acute respiratory failure at admission, these being patients with an increased severity of the acute wheezing episode. Most of the children were born at term, breastfed, with correct vitamin D prophylaxis and complete immunization schedule. Patients enrolled in the study had a minimum of 3 episodes of wheezing and a maximum of 10 episodes in their history, the average for all patients being 4 episodes. We have further analyzed the association between certain known risk factors and the severity of wheezing episodes defined in our case by the presence of clinical signs of respiratory failure, hypoxia and the need for oxygen therapy. The relative risk (RR) and the attributable risk (AR) for each risk factor were calculated. Within the studied group, the most important factors that significantly influenced the severity of wheezing episodes were prematurity, low birth weight, urban environment and the presence of atopy. Conclusions. Children with atopy and multiple risk factors most likely require more control and a more careful assessment the lack of response to antiasthmatic medication requires a careful differential diagnosis. More than one-third of the patients in the group had a history of over 6 episodes of wheezing. Although they had multiple wheezing episodes, they were only intermittently treated for short periods of time. Better implementation of guidelines in current practice and a more effective reevaluation of cases requiring long-term treatment is likely to be needed to reduce the severity of acute wheezing episodes and the need for hospitalization.

Keywords

• recurrent wheezing
• viral induced wheezing
• asthma