JAMA Pediatrics: Allergy/Immunology Topic Collection

Neonatal Lung Function and Later Respiratory Consequences Neonatal Lung Function and Respiratory Consequences

Carlsen K. — Mon, 01 Apr 2013 00:00:00 GMT

Reduced Infant Lung Function, Active Smoking, and Wheeze in 18-Year-Old Individuals Reduced Infant Lung Function, Smoking, and Wheeze

Mullane D, Turner SW, Cox D, et al. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

This is the first study to link reduced lung function in early life, before the development of symptoms, to wheeze in 18-year-olds. Additionally, the study gives insight into factors other than reduced lung function that are also associated with persistent wheeze in young adults.

Objective

To test the hypothesis that reduced lung function in early life is associated with increased risk for persistent wheeze at age 18 years.

Design

Birth cohort study.

Setting

Perth, Western Australia.

Participants

Individuals followed up from age 1 month to 18 years.

Main Outcome Measures

Maximal flow at functional residual capacity (V′maxFRC) was measured in 1-month-old infants who were followed up at ages 6, 12, and 18 years. Based on reported symptoms, individuals were categorized as having remittent wheeze, later-onset wheeze, persistent wheeze, and no wheeze. Smoking status was noted at age 18 years.

Results

Of the 253 individuals originally recruited, 150 were followed up at age 18 years; 37 of the 150 had recent wheeze. Compared with the no-wheeze group (n = 96), persistent wheeze (n = 13) was independently associated with reduced percentage of predicted V′maxFRC (mean reduction, 43%; 95% CI, 13-74). Compared with the no-wheeze group, persistent wheeze was also associated with atopy in infancy (odds ratio = 7.1; 95% CI, 1.5-34.5), maternal asthma (odds ratio = 6.8; 95% CI, 1.4-32.3), and active smoking (odds ratio = 4.8; 95% CI, 1.0-21.3). When only wheeze at age 18 years was considered, reduced percentage of predicted V′maxFRC was associated with wheeze at age 18 years only among current smokers (P = .04).

Conclusions and Relevance

Wheeze persisting from ages 6 to 18 years is associated with multiple factors, including reduced infant lung function, infant-onset atopy, maternal asthma, and active smoking. Wheeze at age 18 years (regardless of previous wheeze status) is associated with active smoking, but only among those with reduced lung function in infancy. These findings give unique insight into the cause of obstructive airways disease in 18-year-olds, and follow-up of this cohort might be expected to further extend our understanding.

A Control Model to Evaluate Pharmacotherapy for Allergic Rhinitis in Children Model for Allergic Rhinitis Pharmacotherapy

Rachelefsky G, Farrar J. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

Although the question of whether early diagnosis and treatment of pediatric allergic rhinitis (AR) improve disease control is important, a more crucial question is whether we can evaluate the effect of treatment on disease control using an impairment-risk model.

Objective

To conduct a systematic review evaluating application of a control model based on domains of impairment and risk (similar to that used for asthma) in pharmacotherapy for children with AR.

Evidence Acquisition

We searched the MEDLINE and EMBASE databases (January 1, 1996, through May 31, 2012) for controlled studies lasting 2 weeks or longer in children with confirmed diagnoses of AR, including measures assessing impairment and/or risk of comorbid conditions.

Results

Sixteen controlled clinical trials, including more than 3000 children (aged 2-18 years) with AR (seasonal, n = 2290; perennial, n = 800), met the study criteria. All medication classes improved impairment related to AR, but between-treatment comparisons were limited because of different assessments. Intranasal steroids improved risk outcomes associated with asthma and obstructive sleep apnea. Small single studies suggested possible effects of oral antihistamines on asthma and sleep-disordered breathing. No risk data were available for nasal antihistamines or montelukast sodium.

Conclusions

Treatment of AR, particularly with intranasal steroids, improves disease control in children by reducing disease-associated impairment and risk. All AR medications with proved efficacy probably improve impairment, paralleling symptom reduction. Intranasal steroids may reduce the likelihood of comorbidities that increase health care use. These observations, although limited by different protocols and outcomes measures among studies, support current practice recommendations. Studies that use standardized measures of impairment to permit better comparison and appropriate protocols for risk evaluation are needed.