Clinical characteristics related to onset age of wheeze in school-age children and adolescents with asthma

Gwang Cheon Jang; Jung Yeon Shim; Young Min Ahn; Jin-A Jung; Sung Won Kim; Hai Lee Chung

doi:10.4168/aard.2015.3.5.326

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Jang, Shim, Ahn, Jung, Kim, Chung, and The Group for the Study of Asthma in Adolescent Children: Clinical characteristics related to onset age of wheeze in school-age children and adolescents with asthma

Original Article

Allergy, Asthma & Respiratory Disease 2015; 3(5): 326-333.

Published online: 30 September 2015

DOI: https://doi.org/10.4168/aard.2015.3.5.326

Clinical characteristics related to onset age of wheeze in school-age children and adolescents with asthma

Gwang Cheon Jang¹, Jung Yeon Shim², Young Min Ahn³, Jin-A Jung⁴, Sung Won Kim⁵, Hai Lee Chung⁶

; The Group for the Study of Asthma in Adolescent Children

¹Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.

²Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

³Department of Pediatrics, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.

⁴Department of Pediatrics, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea.

⁵Department of Pediatrics, Busan St. Mary's Medical Center, Busan, Korea.

⁶Department of Pediatrics, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea.

Correspondence to: Hai Lee Chung. Department of Pediatrics, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea. Tel: +82-53-650-4245, Fax: +82-53-622-4240, hlchung@cu.ac.kr

Received 8 January 2015 Revised 6 July 2015 Accepted 7 July 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Purpose

We aimed to investigate the clinical characteristics and their relationship with the onset age of wheeze in school-age children and adolescents with asthma.

Methods

Three hundred twenty-six patients, aged 6 to 19 years, diagnosed with asthma at 6 hospitals from Seoul, Gyeonggi, Daegu, and Busan were enrolled. They were categorized into 3 groups by the onset age of wheeze: group A, early onset (age <3 years); group B, preschool onset (age 3-6 years); group C, late onset (age ≥6 years). Clinical characteristics including atopic sensitization, family history, combined allergic diseases, severity of asthma, and influence of asthma on daily life were examined. A history of hospitalization for early lower respiratory infection (LRI) and environmental tobacco smoking were studied and lung function tests were also performed.

Results

There was no difference in demographics, prevalence of atopy, combined allergic diseases, and family history of allergy between 3 groups. A history of sever LRI in early life was more common in groups A and B compared with group C. Sensitization to Dermatophagoides pteronyssinus was more prevalent in groups A and B than in group C. Forced expiratory flow between 25% to 75% (FEF_25%-75%) was lower in groups A and B than in group C, and methacholine PC₂₀ (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second) was lowest in group B. Significantly lower FEF_25%-75% and methacholine PC₂₀ were observed in the patients who had been hospitalized with LRI in early life.

Conclusion

Our study shows significant difference in lung function and atopic sensitization in relation to the onset age of wheeze in school-age children and adolescents with asthma, and suggests that early LRI might contribute to the development of asthma in early life.

Keywords: Asthma, Child, Adolescent

Figures and Tables

Fig. 1

Compliance to treatment in three asthma groups. Group A, early onset (age <3 yr); group B, preschool onset (age 3-6 yr); group C, late onset (age ≥6 yr).

Table 1

Clinical characteristics of asthmatic children (n=326)

Characteristic	Value
Age (yr)	10.6 ± 3.1 (6-19)
6-12	254 (78)
13-19	72 (22)
Male sex	211/326 (65)
6-12 yr	168/254 (66)
13-19 yr	43/72 (60)
Asthma was diagnosed
At outpatient clinic	288 (88)
During convalescence after admission	38 (12)
Wheezing began
Group A, < 3 yr	69 (21)
Group B, ≥ 3, < 6 yr	76 (23)
Group C, ≥ 6 yr	181 (56)
Atopic patients	291 (89)
Parental allergic disease	243 (75)
Combined allergic disease
Allergic rhinitis	211 (65)
Atopic dermatitis	159 (49)
Food allergy	61 (19)
Comorbid conditions
Rhinosinusitis	98 (30)
Throat clearing	18 (6)
Frequent deep breaths or hyperventilation	9 (3)
Vocal cord dysfunction	1 (0.3)
Admission with LRI < 3 yr	90 (28)
Exposure to tobacco smoking	166/306 (54)
Indirect	159/166 (96)
Direct	7/166 (4)

Values are presented as mean±standard deviation (range) or number (%).

LRI, lower respiratory infection.

Table 2

Clinical characteristics of three asthma groups

Characteristic	Group A (n = 69)	Group B (n = 76)	Group C (n = 181)	P-value
Age (yr)	10.5 ± 2.9	9.6 ± 2.7	11.0 ± 3.2	0.09
Male sex	46 (67)	50 (66)	115 (64)	0.75
Atopic patients	62 (90)	72 (95)	157 (84)	0.12
Severity of asthma				0.08
Mild intermittent	20/62 (32)	12/68 (18)	60/153 (39)
Mild persistent	24/62 (39)	27/68 (40)	52/153 (34)
Moderate persistent	16/62 (42)	25/68 (38)	35/153 (23)
Severe persistent	2/62 (13)	4/68 (6)	6/153 (4)
Combined allergic disease
Allergic rhinitis	46 (67)	50 (66)	115 (64)	0.82
Atopic dermatitis	39 (57)	41 (54)	79 (44)	0.21
Food allergy	15 (22)	18 (24)	28 (16)	0.34
Comorbid rhinosinusitis	16 (23)	38 (50)	44 (24)	0.001^*
Parental allergic disease	53 (77)	58 (76)	132 (73)	0.85
Total serum IgE (IU/mL)	312 (138.5-720.8)	299 (133.5-776.5)	320 (156.5-783.5)	0.99
Admission with LRI < 3 yr	32 (46)	30 (40)	28 (16)	0.0001^†, 0.0001^‡
Exposure to tobacco smoking	42/65 (65)	37/73 (51)	87/168 (51)	0.09^*, 0.05^†
Difficult asthma	3 (4)	5 (7)	1 (0.6)	0.03^†, 0.003^‡

Values are presented as mean±standard deviation (range), number (%), or median (interquartile range).

LRI, lower respiratory infection; group A, early onset (age <3 yr); group B, preschool onset (age 3-6 yr); group C, late onset (age ≥6 yr).

^*Group A vs. group B. ^†Group A vs. group C. ^‡Group B vs. group C.

Table 3

Sensitization to allergens in three asthma groups

Group	D. farinae	D. pteronyssinus	Tree pollen	Grass pollen	Weed pollen	Mold pollen	Food allergen	Pet allergen	Multiple sensitization
A	54/69 (78)	45/59 (76)	18/69 (26)	7/69 (10)	13/69 (19)	10/69 (10)	7/69 (10)	20/69 (29)	16/69 (23)
B	63/76 (83)	54/65 (83)	9/76 (12)	4/76 (5)	14/76 (18)	12/76 (16)	10/76 (13)	10/76 (32)	21/76 (28)
C	146/181 (81)	59/165 (36)	55/181 (30)	13/181 (7)	34/181 (19)	26/181 (14)	11/181 (6)	11/181 (31)	58/181 (32)
P-value	0.78	0.001^*	0.001^†	0.53	0.85	0.75	0.16	0.42	0.37

Values are presented as number (%).

D. farina, Dermatophagoides farina; D. pteronyssinus, Dermatophagoides pteronyssinus; group A, early onset (age <3 yr); group B, preschool onset (age 3-6 yr); group C, late onset (age ≥6 yr).

^*Groups A, B vs. group C. ^†Group B vs. group C.

Table 4

Lung function parameters in relation to onset age of wheeze and early LRI

Parameter	FEV₁ (%predicted)	FEF_25%-75% (%predicted)	FVC (%predicted)	FEV₁/FVC (%predicted)	PC₂₀ (mg/mL)
Group A	91.5 ± 14.7	72.6 ± 23.5	95.2 ± 10.9	86.6 ± 12.4	2.6 (1.2-8.9)
Group B	87.1 ± 15.8	67.9 ± 24.7	92.8 ± 14.0	86.6 ± 10.5	1.8 (1.0-7.7)
Group C	91.9 ± 17.3	82.6 ± 7.3	95.0 ± 14.2	88.7 ± 11.3	4.8 (1.4-16)
P-value	0.18	0.04^*, 0.002^†	0.56	0.37	0.05^*, 0.02^†
Admission with LRI < 3 yr
Yes	89.5 ± 17.8	71.4 ± 27.3	92.9 ± 13.6	85.9 ± 10.7	1.8 (1.5-13.1)
No	91.6 ± 16.0	79.7 ± 26.2	95.3 ± 13.5	87.9 ± 13.1	4.0 (0.8-15.4)
P-value	0.48	0.03	0.62	0.12	0.01

Values are presented as mean±standard deviation or median (interquartile range). LogPC₂₀ was compared among patient groups.

LRI, lower respiratory infection; FEV₁, forced expiratory volume in 1 second; FEF_25%-75%, forced expiratory flow 25%-75%; FVC, forced vital capacity; PC₂₀, provocative concentration of methacholine causing a 20% fall in FEV₁; group A, early onset (age <3 yr); group B, preschool onset (age 3-6 yr); group C, late onset (age ≥6 yr).

^*Group A vs. group C. ^†Group B vs. group C.

Table 5

Influence of asthma on daily life in three asthma groups

Influence of asthma	Group A (n = 65)	Group B (n = 73)	Group C (n = 168)	P-value
Experience stress	61 (94)	60 (82)	147 (88)	0.1
School disturbance	42 (64)	49 (67)	106 (63)	0.8
Leisure/emotion disturbance	18 (28)	27 (27)	33 (20)	0.3
Outdoor activity
Everyday	29 (45)	29 (40)	98 (58)	0.08^*, 0.01^†
Sometimes	26 (40)	31 (42)	58 (35)	0.7
Never	9 (14)	13 (18)	12 (7)	0.1^*, 0.02^†

Values are presented as number (%).

Group A, early onset (age <3 yr); group B, preschool onset (age 3-6 yr); group C, late onset (age ≥6 yr).

^*Group A vs. group C. ^†Group B vs. group C.

Notes

All authors of this study are members of the Group for the Study of Asthma in Adolescent Children.

This work was supported by Hanwha Research Grant Award from Korean Academy of Allergy and Respiratory Disease in 2010.

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ORCID iDs: Hai Lee Chung
https://orcid.org/http://orcid.org/0000-0002-5364-5318
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