Recurrent wheeze and its relationship with lung function and airway inflammation in preschool children: a cross-sectional study in South Korea

Background

Relationship between recurrent wheeze and airway function and inflammation in preschool children is not fully known.

Objective

To investigate the relationship between recurrent wheeze and airway inflammation, lung function, airway hyper-reactivity (AHR) and atopy in preschool children.

Design

Observational study, comparing forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC) and mid-forced expiratory flow (FEF_25%–75%), dose–response slope (DRS), exhaled nitric oxide (eNO) and atopic sensitisation between children with recurrent wheeze and those without.

Setting

Population-based, cross-sectional study in Seoul and the Gyeonggi province of Korea conducted as a government-funded programme to perform standardised measurement of the prevalence of allergic diseases, and related factors, in preschool children.

Participants

900 children aged 4–6 years.

Primary and secondary outcome measures

eNO, FEV₁/FVC, FEF_25%–75%, DRS, atopic sensitisation and allergic diseases.

Methods

Children completed the modified International Study of Asthma and Allergies in Childhood questionnaire and underwent eNO assessments, spirometry, methacholine bronchial provocation tests and skin prick tests. Recurrent wheeze was defined as having a lifetime wheeze of more than three episodes, based on the questionnaire. The frequency of hospitalisation and emergency room visits was also obtained by means of the questionnaire. 'Current' wheeze was defined as having symptoms or treatments within the past 12 months.

Results

The prevalence of recurrent wheeze was 13.4%. Children with recurrent wheeze showed a higher prevalence of lifetime or current allergic rhinitis (p=0.01 and p=0.002, respectively) and lifetime atopic dermatitis (p=0.007). Children with recurrent wheeze showed lower FEV₁/FVC (p=0.033) and FEF_25%–75% (p=0.004), and higher eNO levels (p=0.013) than those without recurrent wheeze. However, the DRS, prevalence of atopic sensitisation and serum IgE levels were not significantly different between the two groups.

Conclusions

Recurrent wheeze in preschool children may be associated with airway inflammation and diminished airway function, but not with AHR or atopy.

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