Aggiornamento
Il “fischio” dalla nascita in poi: inquadramento diagnostico e prognostico delle sindromi asmatiformi
“WHEEZING” IN THE FIRST YEARS OF LIFE
GIORGIO LONGO
Clinica Pediatrica, IRCCS “Burlo Garofolo”, Trieste
Giugno 2003 - pagg. 363 -368
Abstract
The article provides an overview of the clinical and epidemiological features of wheezing in
the first years of life, with specific attention paid to prognostic aspects. Wheezing bronchitis
is triggered by viral infections, Mycoplasma pneumoniae and Chlamydia being responsible
for 5% of cases, mostly in older children. In the majority of cases, wheezing episodes disappear
by early school years. In about 20% of children, acute episodes are followed by bronchial
inflammation, symptoms became more severe and bronchial remodelling may occur. Risk
factors are positive family history, atopic dermatitis, positivity to cutaneous prick tests for
pneumo-allergens and wheezing outside acute episodes. Inhaled steroids are not effective in
preventing the recurrence of wheezing bronchitis, although they may be useful in allergic
subjects who are symptomatic beyond the acute episodes.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Luyt DK, Burton PR, Simpson H. Epidemiological
study of wheeze, doctor diagnosed
asthma, and cough in preschool children in
Leicestershire. BMJ 1993;306(6889):1386-90.
2. Wilson NM. The significance of early wheezing. Clin Exp Allergy 1994;24:522-9.
3. Akinbami LJ, Schoendorf KC. Trends in childhood asthma: prevalence, health care utilization, and mortality. Pediatrics 2002; 110: 315-22.
4. Martinez FD, Wright AL, Taussig LM, et al. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med 1995;332:133-8.
5. Park ES, Golding J, Carswell F, Stewart- Brown S. Preschool wheezing and prognosis at 10. Arch Dis Child 1986;61(7):642-6.
6. Martinati LC, Boner A. Clinical diagnosis of wheezing in early childhood. Allergy 1995; 50(9):701-10.
7. Croner S, Kjellman NI. Natural history of bronchial asthma in childhood. A prospective study from birth up to 12-14 years of age. Allergy 1992;47(2 Pt 2):150-7.
8. Warner JO, Pohunek P, Marguet C, Roche WR, Clough JB. Issues in understanding childhood asthma. J Allergy Clin Immunol 2000;105: S473-6.
9. Freymuth F, Vabret A, Brouard J, et al. Detection of viral, Chlamydia pneumoniae and Mycoplasma pneumoniae infections in exacerbations of asthma in children. J Clin Virol 1999; 13(3):131-9.
10. Gershel JC, Goldman HS, Stein RE, Shelov SP, Ziprkowski M. The usefulness of chest radiographs in first asthma attacks. N Engl J Med 1983;309:336-9.
11. Stevenson EC, Turner G, Heaney LG, et al. Bronchoalveolar lavage findings suggest two different forms of childhood asthma. Clin Exp Allergy 1997;27(9):1027-35.
12. Wilson NM, Phagoo SB, Silverman M. Atopy, bronchial responsiveness, and symptoms in wheezy 3 year olds. Arch Dis Child 1992;67:491-5.
13. Longo G, Strinati R, Poli F, Fumi F. Genetic factors in non specific bronchial hyperactivity. Am J Dis Childh 1987;14:331-4.
14. Igarashi T, Yoshizumi A. Longitudinal study of bronchial hyperreactivity. In: Adachi Y, Murakami G, Matsuno M, et al. Reschool children with bronchial asthma. Ann Allergy 1992;68:261-6.
15. Strachan D, Gerritsen J. Long-term outcome of early childhood wheezing: population data. Eur Respir J Suppl 1996;21:42s-47s.
16. Sporick R, Holgate ST, Cogswell JJ. Natural hystory of asthma in childhood a birth cohort study. Arch Dis Child 1991;66:1050-8.
17. Zimmerman B, Feanny S, Reisman J, et al. Allergy in asthma. I. The dose relationship of allergy to severity of childhood asthma. J Allergy Clin Immunol 1988;81:63-70.
18. Delacourt C, Labbe D, Vassault A, et al. Sensitization to inhalant allergens in wheezing infants is predictive of the development of infantile asthma. Allergy 1994;49:843-7.
19. Foucard T, Sjoberg O. A prospective 12- year follow-up study of children with wheezy bronchitis. Acta Paediatr Scand 1984;73(5): 577-83.
20. Holgate ST. Whot does infiammation and airway remodelling mean? Clin Exp All Rev 2001;1(2):59-61.
21. Oswald H, Phelan PD, Lanigan A, et al. Childhood asthma and lung function in midadult life. Pediatr Pulmonol 1997;23(1):14-20.
22. Chavasse RJ, Bastian-Lee Y, Richter H, et al. Persistent wheezing in infants with an atopic tendency responds to inhaled fluticasone. Arch Dis Child 2001;85(2):143-8.
23. Pao CS, McKenzie SA. Randomized controlled trial of fluticasone in preschool children with intermittent wheeze. Am J Respir Crit Care Med 2002;166(7):945-9.
24. Martinez FD. Present and future treatment af asthma in infants and young children. J Allergy Clin Immunol 1999;104:S169-74.
25. Pedersen S. Early use of inhaled steroids in children with asthma. Clin Exp Allergy 1997; 27: 995-9.
26. Doull IJ. Limitations of maintenance therapy for viral respiratory infection-induced asthma. J Pediatr 2003;142(2 Suppl):S21-4.
27. Position statement. Environmental allergen avoidance in allergic asthma. Ad Hoc Working Group on Environmental Allergens and Asthma. J Allergy Clin Immunol 1999;103(2 Pt 1):203-5.
28. Longo G. Epidemiologia e manifestazioni cliniche della rinite allergica nel bambino. RIAIP (Rivista Immunologia e Allergologia Pediatrica) 2003;17(Suppl. 1):1-6.
29. Kjellman B, Hesselmar B. Prognosis of asthma in children: a cohort study into adulthood. Acta Paediatr 1994;83(8):854-61.
30. Castro-Rodriguez JA, Holberg CJ, Wright AL, Martinez FD. A clinical index to define risk of asthma in young children with recurrent wheezing. Am J Respir Crit Care Med 2000; 162:1403-6.
31. Clough JB, Keeping KA, Edwards LC, et al. Can we predict which wheezy infants will continue to wheeze? Am J Respir Crit Care Med 1999;160(5 Pt 1):1473-80.
32. Burr ML, Merrett TG, Dunstan FD, Maguire MJ. The development of allergy in highrisk children. Clin Exp Allergy 1997 Nov; 27(11):1247-53.
33. Martoccia M. I prick test. In: Fai da te per il pediatra. D’Andrea N, Barbi E, Panizon F (Eds). Trieste: Edizioni Medico e Bambino, 2002:101-9.
34. Martinez FD, Morgan WJ, Wright AL, et al. Diminished lung function as a predisposing factor for wheezing respiratory illness in infants. N Engl J Med 1988;319:1112-7.
35. Martinez FD, Morgan WJ, Wright AL, et al. Initial airway function is a risk factor for recurrent wheezing respiratory illnesses during the first three years of life. Group Health Medical Associates. Am Rev Respir Dis 1991;143(2): 312-6.
36. Hogg JC, Williams J, Richardson JB, et al. Age as factor in the distribution of lowerairway conductance and in the pathologic anatomy of obstructive lung disease. N Engl J Med 1970;282:1283-7.
37. Silverman M. Out of the mouths of babes and sucklings: lessons from early childhood asthma. Thorax 1993;48(12):1200-4.
38. Silverman M. Bronchodilators for wheezy infants?Arch Dis Child 1984;59(1):84-7.
39. Lowell DI, Lister G, Von Koss H. Wheezing in infants: the response to epinephrine. Pediatrics 1987;79:939-45.
40. Taussig LM. The conundrum of wheezing and airway hyperreactivity in infancy. Pediatr Pulmonol 1992;13(1):1-3.
41. Panizon F. Esiste lo “happy wheezer”? Medico e Bambino 1991;10;645-8.
42. Pahor T, Poli F, Longo G. “Happy wheezer”: caratteristiche cliniche e storia naturale. (in press).
43. Hogg C, Bush A. Childhood asthma-all that wheezes is not inflammation. Clin Exp Allergy 1997;27(9):991-4.
44. Muller NL, Bryan AC. Chest wall mechanics and respiratory muscles in infants. Pediatr Clin North Amer 1979;26:503-62.
45. Rakshi K, Couriel JM. Management of acute bronchiolitis. Arch Dis Child 1994;71(5): 463-9.
46. Patel H, Platt RW, Pekeles GS, Ducharme FM. A randomized, controlled trial of the effectiveness of nebulized therapy with epinephrine compared with albuterol and saline in infants hospitalized for acute viral bronchiolitis. J Pediatr 2002;141:818-24.
47. Meates M. Does nebulised adrenaline (epinephrine) reduce admission rate in bronchiolitis? Arch Dis Child 2002;87(6):548-50.
48. Kattan M. Epidemiologic evidence of increased airway reactivity in children with a history of bronchiolitis. J Pediatr 1999;135:8-13.
49. Welliver RC, Sun M, Rinaldo D, Ogra PL. Predictive value of respiratory syncytial virusspecific IgE responses for recurrent wheezing following bronchiolitis. J Pediatr 1986;109(5) :776-80.
50. Welliver RC, Duffy L. The relationship of RSV-specific immunoglobulin E antibody responses in infancy, recurrent wheezing, and pulmonary function at age 7-8 years. Pediatr Pulmunol 1993;15(1):19-27.
51. Stein RT, Sherrill D, Morgan WJ, et al. Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years. Lancet 1999;354:541-5.
2. Wilson NM. The significance of early wheezing. Clin Exp Allergy 1994;24:522-9.
3. Akinbami LJ, Schoendorf KC. Trends in childhood asthma: prevalence, health care utilization, and mortality. Pediatrics 2002; 110: 315-22.
4. Martinez FD, Wright AL, Taussig LM, et al. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med 1995;332:133-8.
5. Park ES, Golding J, Carswell F, Stewart- Brown S. Preschool wheezing and prognosis at 10. Arch Dis Child 1986;61(7):642-6.
6. Martinati LC, Boner A. Clinical diagnosis of wheezing in early childhood. Allergy 1995; 50(9):701-10.
7. Croner S, Kjellman NI. Natural history of bronchial asthma in childhood. A prospective study from birth up to 12-14 years of age. Allergy 1992;47(2 Pt 2):150-7.
8. Warner JO, Pohunek P, Marguet C, Roche WR, Clough JB. Issues in understanding childhood asthma. J Allergy Clin Immunol 2000;105: S473-6.
9. Freymuth F, Vabret A, Brouard J, et al. Detection of viral, Chlamydia pneumoniae and Mycoplasma pneumoniae infections in exacerbations of asthma in children. J Clin Virol 1999; 13(3):131-9.
10. Gershel JC, Goldman HS, Stein RE, Shelov SP, Ziprkowski M. The usefulness of chest radiographs in first asthma attacks. N Engl J Med 1983;309:336-9.
11. Stevenson EC, Turner G, Heaney LG, et al. Bronchoalveolar lavage findings suggest two different forms of childhood asthma. Clin Exp Allergy 1997;27(9):1027-35.
12. Wilson NM, Phagoo SB, Silverman M. Atopy, bronchial responsiveness, and symptoms in wheezy 3 year olds. Arch Dis Child 1992;67:491-5.
13. Longo G, Strinati R, Poli F, Fumi F. Genetic factors in non specific bronchial hyperactivity. Am J Dis Childh 1987;14:331-4.
14. Igarashi T, Yoshizumi A. Longitudinal study of bronchial hyperreactivity. In: Adachi Y, Murakami G, Matsuno M, et al. Reschool children with bronchial asthma. Ann Allergy 1992;68:261-6.
15. Strachan D, Gerritsen J. Long-term outcome of early childhood wheezing: population data. Eur Respir J Suppl 1996;21:42s-47s.
16. Sporick R, Holgate ST, Cogswell JJ. Natural hystory of asthma in childhood a birth cohort study. Arch Dis Child 1991;66:1050-8.
17. Zimmerman B, Feanny S, Reisman J, et al. Allergy in asthma. I. The dose relationship of allergy to severity of childhood asthma. J Allergy Clin Immunol 1988;81:63-70.
18. Delacourt C, Labbe D, Vassault A, et al. Sensitization to inhalant allergens in wheezing infants is predictive of the development of infantile asthma. Allergy 1994;49:843-7.
19. Foucard T, Sjoberg O. A prospective 12- year follow-up study of children with wheezy bronchitis. Acta Paediatr Scand 1984;73(5): 577-83.
20. Holgate ST. Whot does infiammation and airway remodelling mean? Clin Exp All Rev 2001;1(2):59-61.
21. Oswald H, Phelan PD, Lanigan A, et al. Childhood asthma and lung function in midadult life. Pediatr Pulmonol 1997;23(1):14-20.
22. Chavasse RJ, Bastian-Lee Y, Richter H, et al. Persistent wheezing in infants with an atopic tendency responds to inhaled fluticasone. Arch Dis Child 2001;85(2):143-8.
23. Pao CS, McKenzie SA. Randomized controlled trial of fluticasone in preschool children with intermittent wheeze. Am J Respir Crit Care Med 2002;166(7):945-9.
24. Martinez FD. Present and future treatment af asthma in infants and young children. J Allergy Clin Immunol 1999;104:S169-74.
25. Pedersen S. Early use of inhaled steroids in children with asthma. Clin Exp Allergy 1997; 27: 995-9.
26. Doull IJ. Limitations of maintenance therapy for viral respiratory infection-induced asthma. J Pediatr 2003;142(2 Suppl):S21-4.
27. Position statement. Environmental allergen avoidance in allergic asthma. Ad Hoc Working Group on Environmental Allergens and Asthma. J Allergy Clin Immunol 1999;103(2 Pt 1):203-5.
28. Longo G. Epidemiologia e manifestazioni cliniche della rinite allergica nel bambino. RIAIP (Rivista Immunologia e Allergologia Pediatrica) 2003;17(Suppl. 1):1-6.
29. Kjellman B, Hesselmar B. Prognosis of asthma in children: a cohort study into adulthood. Acta Paediatr 1994;83(8):854-61.
30. Castro-Rodriguez JA, Holberg CJ, Wright AL, Martinez FD. A clinical index to define risk of asthma in young children with recurrent wheezing. Am J Respir Crit Care Med 2000; 162:1403-6.
31. Clough JB, Keeping KA, Edwards LC, et al. Can we predict which wheezy infants will continue to wheeze? Am J Respir Crit Care Med 1999;160(5 Pt 1):1473-80.
32. Burr ML, Merrett TG, Dunstan FD, Maguire MJ. The development of allergy in highrisk children. Clin Exp Allergy 1997 Nov; 27(11):1247-53.
33. Martoccia M. I prick test. In: Fai da te per il pediatra. D’Andrea N, Barbi E, Panizon F (Eds). Trieste: Edizioni Medico e Bambino, 2002:101-9.
34. Martinez FD, Morgan WJ, Wright AL, et al. Diminished lung function as a predisposing factor for wheezing respiratory illness in infants. N Engl J Med 1988;319:1112-7.
35. Martinez FD, Morgan WJ, Wright AL, et al. Initial airway function is a risk factor for recurrent wheezing respiratory illnesses during the first three years of life. Group Health Medical Associates. Am Rev Respir Dis 1991;143(2): 312-6.
36. Hogg JC, Williams J, Richardson JB, et al. Age as factor in the distribution of lowerairway conductance and in the pathologic anatomy of obstructive lung disease. N Engl J Med 1970;282:1283-7.
37. Silverman M. Out of the mouths of babes and sucklings: lessons from early childhood asthma. Thorax 1993;48(12):1200-4.
38. Silverman M. Bronchodilators for wheezy infants?Arch Dis Child 1984;59(1):84-7.
39. Lowell DI, Lister G, Von Koss H. Wheezing in infants: the response to epinephrine. Pediatrics 1987;79:939-45.
40. Taussig LM. The conundrum of wheezing and airway hyperreactivity in infancy. Pediatr Pulmonol 1992;13(1):1-3.
41. Panizon F. Esiste lo “happy wheezer”? Medico e Bambino 1991;10;645-8.
42. Pahor T, Poli F, Longo G. “Happy wheezer”: caratteristiche cliniche e storia naturale. (in press).
43. Hogg C, Bush A. Childhood asthma-all that wheezes is not inflammation. Clin Exp Allergy 1997;27(9):991-4.
44. Muller NL, Bryan AC. Chest wall mechanics and respiratory muscles in infants. Pediatr Clin North Amer 1979;26:503-62.
45. Rakshi K, Couriel JM. Management of acute bronchiolitis. Arch Dis Child 1994;71(5): 463-9.
46. Patel H, Platt RW, Pekeles GS, Ducharme FM. A randomized, controlled trial of the effectiveness of nebulized therapy with epinephrine compared with albuterol and saline in infants hospitalized for acute viral bronchiolitis. J Pediatr 2002;141:818-24.
47. Meates M. Does nebulised adrenaline (epinephrine) reduce admission rate in bronchiolitis? Arch Dis Child 2002;87(6):548-50.
48. Kattan M. Epidemiologic evidence of increased airway reactivity in children with a history of bronchiolitis. J Pediatr 1999;135:8-13.
49. Welliver RC, Sun M, Rinaldo D, Ogra PL. Predictive value of respiratory syncytial virusspecific IgE responses for recurrent wheezing following bronchiolitis. J Pediatr 1986;109(5) :776-80.
50. Welliver RC, Duffy L. The relationship of RSV-specific immunoglobulin E antibody responses in infancy, recurrent wheezing, and pulmonary function at age 7-8 years. Pediatr Pulmunol 1993;15(1):19-27.
51. Stein RT, Sherrill D, Morgan WJ, et al. Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years. Lancet 1999;354:541-5.