Management of Prematurity-Associated Wheeze and Its Association with Atopy

Abstract

Introduction: Although preterm birth is associated with respiratory morbidity in childhood, the role of family history of atopy and whether appropriate treatment has been instituted is unclear. Thus we assessed (i) the prevalence of respiratory symptoms, particularly wheezing, in childhood; (ii) evaluated the role of family history of atopy and mode of delivery, and (iii) documented the drug usage, all in preterm-born children compared to term-born control children.

Methods: We conducted a cross-sectional population-based questionnaire study of 1-10 year-old preterm-born children (n = 13,361) and matched term-born controls (13,361). Data (n = 7,149) was analysed by gestational groups (24-32 weeks, 33-34 weeks, 35-36 weeks and 37-43 weeks) and by age, <5 years old or ≥ 5 years.

Main results: Preterm born children aged <5 years (n = 2,111, term n = 1,402) had higher rates of wheeze-ever [odds ratio: 2.7 (95% confidence intervals 2.2, 3.3); 1.8 (1.5, 2.2); 1.5 (1.3, 1.8) respectively for the 24-32 weeks, 33-34 weeks, 35-36 weeks groups compared to term]. Similarly for the ≥5 year age group (n = 2,083, term n = 1,456) wheezing increased with increasing prematurity [odds ratios 3.3 (2.7, 4.1), 1.8 (1.5, 2.3) and 1.6 (1.3, 1.9) for the three preterm groups compared to term]. At both age groups, inhaler usage was greater in the lowest preterm group but prematurity-associated wheeze was independent of a family history of atopy.

Conclusions: Increasing prematurity was associated with increased respiratory symptoms, which were independent of a family history of atopy. Use of bronchodilators was also increased in the preterm groups but its efficacy needs careful evaluation.

Fig 1. Diagram showing return rates of completed questionnaires in the Respiratory and Neurological Outcomes of children born Preterm Study (RANOPS).

Fig 2. Prevalence of ever wheezing for the whole study population.

Bars denote the percentage of children having ever wheezed who have a family history of atopy (white bars) or not (black bars) and for both gestational groups, preterm or term.

Fig 3. Prevalence of inhaler treatment amongst wheezing children.

Bars denote the percentage of wheezy children being treated with inhalers who have a family history of atopy (white bars) or not (black bars) and for both gestational groups, preterm or term.