Recurrent wheeze in early childhood and asthma among children at risk for atopy.

OBJECTIVES: Little is known about the natural history of wheezing disorders among children at risk for atopy. We examined the relation between early wheeze and asthma at 7 years of age among children with parental history of asthma or allergies followed from birth.

METHODS: Information on wheeze was collected bimonthly from birth to age 24 months and every 6 months thereafter. Recurrent early wheeze was defined as > or =2 reports of wheezing in the first 3 years of life. Frequent early wheeze was defined as > or =2 reports of wheezing per year in the first 3 years of life. At 7 years of age, asthma was defined as physician-diagnosed asthma and wheezing in the previous year.

RESULTS: Of the 440 participating children, 223 (50.7%) had > or =1 report of wheeze before 3 years old, 111 (26.0%) had recurrent early wheeze, and 12 (2.7%) had frequent early wheeze. Whereas only 31 (13.9%) of 223 children with > or =1 report of wheeze developed asthma at 7 years of age, 24 (21.6%) of 111 children with recurrent early wheeze developed asthma at 7 years of age. Among the 12 children with frequent early wheeze, 6 (50%) had asthma at 7 years of age. After adjustment for other covariates, recurrent early wheeze in children at risk for atopy was associated with a fourfold increase in the odds of asthma at 7 years of age, and frequent early wheeze was associated with an approximately 12-fold increase in the odds of asthma at 7 years of age. Most (94%) of the children without frequent early wheeze did not develop asthma at 7 years of age.

CONCLUSIONS: The absence of recurrent early wheeze indicates a very low risk of asthma at school age among children with parental history of asthma or allergies. Early identification of children who will develop asthma at school age is difficult, even in children at risk for atopy. However, children with parental history of asthma or allergies who have frequent early wheeze, in particular, are at greatly increased risk of asthma and merit close clinical follow-up.