Risk and Protective Factors for Childhood Asthma: What Is the Evidence?

Abstract

To summarize the principal findings on risk and protective factors for childhood asthma, we retrieved systematic reviews on these topics in children (aged 1 to 18 years), up to January 2016, through MEDLINE, EMBASE, CINAHL, SCOPUS, and CDSR. A total of 227 studies were searched from databases. Among those, 41 systematic reviews (SRs) were included: 9 focused on prenatal factors, 5 on perinatal factors, and 27 on postnatal factors. Of these 41 SRs, 83% had good methodological quality, as determined by the Assess Systematic Reviews tool. After reviewing all evidence, parental asthma, prenatal environmental tobacco smoke, and prematurity (particularly very preterm birth) are well-established risk factors for childhood asthma. Current findings do suggest mild-to-moderate causal effects of certain modifiable behaviors or exposures during pregnancy (maternal weight gain or obesity, maternal use of antibiotics or paracetamol, and maternal stress), the perinatal period (birth by Caesarean delivery), or postnatal life (severe respiratory syncytial virus infection, overweight or obesity, indoor exposure to mold or fungi, and outdoor air pollution) on childhood asthma, but this suggestive evidence must be confirmed in interventional studies or (if interventions are not feasible) well-designed prospective studies.

Keywords: Asthma; Children; Meta-analysis; Protective factors; Risk factors; Wheeze.

Figure 1

Study selection flowchart.

Figure 2

Odds ratio (OR) or relative risk (RR) (and 95% confidence intervals) for childhood asthma or wheeze from systematic reviews of familial or prenatal factors (2a), perinatal factors (2b), and postnatal factors (2c). The OR or RR were chosen for asthma if available, or for current wheezing otherwise. When two ORs or RRs existed for the same outcome, we selected the highest estimate for risk factors and the lowest estimate for protective factors.

Figure 2

Odds ratio (OR) or relative risk (RR) (and 95% confidence intervals) for childhood asthma or wheeze from systematic reviews of familial or prenatal factors (2a), perinatal factors (2b), and postnatal factors (2c). The OR or RR were chosen for asthma if available, or for current wheezing otherwise. When two ORs or RRs existed for the same outcome, we selected the highest estimate for risk factors and the lowest estimate for protective factors.

Figure 2

Odds ratio (OR) or relative risk (RR) (and 95% confidence intervals) for childhood asthma or wheeze from systematic reviews of familial or prenatal factors (2a), perinatal factors (2b), and postnatal factors (2c). The OR or RR were chosen for asthma if available, or for current wheezing otherwise. When two ORs or RRs existed for the same outcome, we selected the highest estimate for risk factors and the lowest estimate for protective factors.