Prevalence of recurrent wheezing in infants and toddlers in Barbados: findings from a prospective study of a cohort of babies born during 2015–2017
Main Article Content
Keywords
infants, toddlers, prevalence, asthma predictive index, recurrent wheezing
Abstract
Objectives: The main objective was to determine the prevalence of recurrent wheezing (RW) among infants and toddlers as well as the prevalence of asthma predictive risk factors among those with RW.
Materials and methods: A prospective study of a cohort of babies recruited after their birth during July 2015–June 2017. Mothers were contacted using the WhatsApp messaging system for digital follow-up on their baby’s condition at 3-monthly intervals until they were 18 months old. Information on wheezing and its correlates were collected by digital follow-up and corroborated at an in-person interview and examination of their baby at 18 months of age. Recurrent wheezing was defined as more than three episodes of wheezing or its correlates during the follow-up period.
Results: There were 338 males (41.5%) and 476 (58.5%) females. Overall, 31.1% (95% CI = 27.9%, 34.4%) had RW by 18 months and the same number had RW during their first year of life. Of the infants with RW, 121 (47.8%; 95% CI = 41.6, 54.2) had at least one or both of the major criteria and/or at least two minor criteria of the stringent Asthma Predictive Index (API). Of those with RW, 32.0% received antihistamine and 20% had received antibiotics on their last visit to a physician for wheezing or symptoms of cough, cold, and/or breathing difficulty.
Conclusions: Nearly a third of infants and toddlers had RW and nearly half of the infants with RW had risk factors fulfilling the criteria of the stringent API.
References
2. Reddy MB, Covar RA. Asthma phenotypes in childhood. Curr Opin Allergy Clin Immunol. 2016;16(2):127–134. 10.1097/ACI.0000000000000252
3. Bousquet J, Anto J, Auffray C, Akdis M, Cambon-Thomsen A, Keil T, et al. MeDALL (Mechanisms of the Development of ALLergy): an integrated approach from phenotypes to systems medicine. Allergy. 2011;66:596–604. 10.1111/j.1398-9995.2010.02534.x
4. Spycher BD, Silverman M, Pescatore AM, Beardsmore CS, Kuehni CE. Comparison of phenotypes of childhood wheeze and cough in 2 independent cohorts. J Allergy Clin Immunol. 2013 Nov 132(5):1058–1067. 10.1016/j.jaci.2013.08.002
5. Lötvall J, Akdis CA, Bacharier LB, Bjermer L, Casale TB, Custovic A, et al. Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome. J Allergy Clin Immunol. 2011;127:355–360. 10.1016/j.jaci.2010.11.037
6. Taussig LM, Wright AL, Holberg CJ, Halonen M, Morgan WJ, Martinez FD. Tucson Children’s Respiratory Study: 1980 to present. J Allergy Clin Immunol. 2003;111(4):661–675. 10.1067/mai.2003.162
7. Sears MR, Greene JM, Willan AR, Wiecek EM, Taylor DR, Flannery EM, et al. A longitudinal, population-based, cohort study of childhood asthma followed to adulthood. N Engl J Med. 2003;349(15):1414–1422. 10.1056/NEJMoa022363
8. Savenije OE, Granell R, Caudri D, Koppelman GH, Smit HA, Wijga A, et al. Comparison of childhood wheezing phenotypes in 2 birth cohorts: ALSPAC and PIAMA. J Allergy Clin Immunol. 2011;127:1505–1512. 10.1016/j.jaci.2011.02.002
9. Custovic A, Soderstrom L, Ahlstedt S, Sly PD, Simpson A, Holt PG. Allergen-specific IgG antibody levels modify the relationship between allergen-specific IgE and wheezing in childhood. J Allergy Clin Immunol. 2011;127:1480–1485. 10.1016/j.jaci.2011.03.014
10. Castro-Rodriguez JA. The Asthma Predictive Index: early diagnosis of asthma. Curr Opin Allergy Clin Immunol. 2011;11:157–161. 10.1097/ACI.0b013e3283464c4a
11. Martinez FD. What have we learned from the Tucson Children’s Respiratory Study? Paediatr Respir Rev. 2002;3:193–197. 10.1016/S1526-0542(02)00188-4
12. Rodriguez-Martinez CE, Sossa-Briceno MP, Castro-Rodriguez JA. Discriminative properties of two predictive indices for asthma diagnosis in a sample of preschoolers with recurrent wheezing. Pediatr Pulmonol. 2011;46:1175–1181. 10.1002/ppul.21493
13. Leonardi NA, Spycher BD, Strippoli MP, Frey U, Silverman M, Kuehni CE. Validation of the Asthma Predictive Index and comparison with simpler clinical prediction rules. J Allergy Clin Immunol. 2011;127:1466–1472. 10.1016/j.jaci.2011.03.001
14. Fouzas S, Brand PL. Predicting persistence of asthma in preschool wheezers: crystal balls or muddy waters? Paediatr Respir Rev. 2013;14:46–52. 10.1016/j.prrv.2012.08.004
15. Caudri D, Wijga AH, Smit HA, Koppelman GH, Kerkhof M, Hoekstra MO, et al. Asthma symptoms and medication in the PIAMA birth cohort: evidence for under and overtreatment. Pediatr Allergy Immunol. 2011;22:652–659. 10.1111/j.1399-3038.2011.01193.x
16. Howitt ME, Roach TC, Naidu R. Prevalence of asthma and wheezing illnesses in Barbadian school children: the Barbados National Asthma & Allergy Study [Abstract]. West Indian Med J. 1998;47 (Suppl 2):22–23.
17. Kumar A, Cherian J. Trends in hospitalization and mortality pattern among children in Barbados, 1987-98. West Indian Med J. 2000;49 (suppl.):XX.
18. Mallol J, García-Marcos L, Aguirre V, Martinez-Torres A, Perez-Fernández V, Gallardo A, et al. The International Study of Wheezing in Infants: questionnaire validation. Int Arch Allergy Immunol. 2007;144(1):44–50. 10.1159/000102613
19. Chong Neto HJ, Rosario N, Dela Bianca AC, Solé D, Mallol J. Validation of a questionnaire for epidemiologic studies of wheezing in infants. Pediatr Allergy Immunol. 2007 Feb 18(1):86–87. 10.1111/j.1399-3038.2006.00488.x
20. Huffaker MF, Phipatanakul W. Utility of the Asthma Predictive Index in predicting childhood asthma and identifying disease-modifying interventions. Ann Allergy Asthma Immunol. 2014;112(3):188–190. 10.1016/j.anai.2013.12.001
21. Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006;368:733–743. 10.1016/S0140-6736(06)69283-0
22. Mallol J, García-Marcos L, Solé D, Brand P, EISL Study Group. International prevalence of recurrent wheezing during the first year of life: variability, treatment patterns and use of health resources. Thorax. 2010;65:1004–1009. 10.1136/thx.2009.115188
23. Assis EV, Sousa MNA, Feitosa MNA, Souza ACC, Leitao PA, Quental OB, et al. Prevalence of recurrent wheezing and its risk factors. Rev. bras. development growth. Hmm. [online]. 2014;24(1):80–85 [cited 2020-07-10].
24. Chong-Neto HJ, Silva Ferreira WF, Urrutia-Pereira M, Solé D, Rosário NA. Recurrent wheezing in infancy: Is the tropic different? Ann Allergy Asthma Immunol. 2020;125(1):115. 10.1016/j.anai.2020.02.015
25. Guilbert TW. Identifying and managing the infant and toddler at risk for asthma. J Allergy Clin Immunol. 2010;126(2):417–422. 10.1016/j.jaci.2010.06.024
26. Akpinar-Elci M, Martin FE, Behr JG, Diaz R. Saharan dust, climate variability, and asthma in Grenada, the Caribbean. Int J Biometeorol. 2015;59(11):1667–1671. 10.1007/s00484-015-0973-2
27. Cadelis G, Tourres R, Molinie J. Short-term effects of the particulate pollutants contained in Saharan dust on the visits of children to the emergency department due to asthmatic conditions in Guadeloupe (French Archipelago of the Caribbean). PLoS One. 2014;9(3):e91136. 10.1371/journal.pone.0091136
28. Gyan K, Henry W, Lacaille S, Laloo A, Lamsee-Ebanks C, McKay S, et al. African dust clouds are associated with increased paediatric asthma accident and emergency admissions on the Caribbean island of Trinidad. Int J Biometeorol. 2005;49(6):371–376. 10.1007/s00484-005-0257-3
29. Kumar A, Krishnamurthy K, Belgrave N. Burden of hospitalizations and mortality from acute severe asthma among children in Barbados, 2013-2016. 64th Annual CARPHA Health Research Conference, Port of Spain, 20–22 June, 2019.
30. Thongkham D, Tran J, Clunes MT, Brahim F. Prevalence and severity of asthmatic symptoms in Grenadian school children: the Grenada National Asthma Survey. BMJ Open. 2015 Oct 19;5(10):e008557. 10.1136/bmjopen-2015-008557
31. Bessa OA, Leite ÁJ, Solé D, Mallol J. Prevalence and risk factors associated with wheezing in the first year of life. J Pediatr (Rio J). 2014;90(2):190–196. 10.1016/j.jped.2013.08.007
32. Kuehni CE, Strippoli MP, Low N, Brooke AM, Silverman M. Wheeze and asthma prevalence and related health-service use in white and South Asian pre-schoolchildren in the United Kingdom. Clin Exp Allergy. 2007;37:1738e46. 10.1111/j.1365-2222.2007.02784.x
33. Guilbert TW, Mauger DT, Lemanske RF. Childhood asthma-predictive phenotype. J Allergy Clin Immunol Pract. 2014;2:664–670. 10.1016/j.jaip.2014.09.010
34. Meltzer EO, Blaiss MS, Naclerio RM, Stoloff SW, Derebery MJ, Nelson HS, et al. Burden of allergic rhinitis: allergies in America, Latin America, and Asia-Pacific adult surveys. Allergy Asthma Proc. 2012;33:S113–S141. 10.2500/aap.2012.33.3603
35. Biagini JM, LeMasters GK, Ryan PH, Levin L, Reponen T, Bernstein TI, et al. Environmental risk factors of rhinitis in early infancy. Pediatr Allergy Immunol. 2006;17(4):278–284. 10.1111/j.1399-3038.2006.00386.x
36. Kumar A, Singh K, Krishnamurthy K, Nielsen LA. Exploring the role of the public and private funded primary health care facilities for children in a pluralistic health care setting of Barbados–one of the English Caribbean countries. Int J Prev Med. 2015;6(11):116–120. doi: 10.4103/2008-7802.169073
37. Heilborn H, Pegelow K-O, Odeblad E. Effect of bromhexine and guaiphenesine on clinical state, ventilatory capacity and sputum viscosity in chronic asthma. Scand J Respir Dis. 1976;57(2):88–96.
38. Beigelman A, Bacharier LB. Management of preschool recurrent wheezing and asthma: a phenotype-based approach. Curr Opin Allergy Clin Immunol. 2017;17(2):131–138. 10.1097/ACI.0000000000000344