OUTCOME OF WHEEZE IN CHILDHOOD - SYMPTOMS AND PULMONARY-FUNCTION 25 YEARS LATER

The outcome after 25 yr was studied for three groups of children class ified in a random community survey in 1964 as having asthma (121 subje cts), wheeze in the presence of infection (167 subjects), or no respir atory symptoms (167 comparison subjects). Approximately 80% of the sub jects in each group, now aged 34 to 40 yr, were successfully traced. C urrent symptoms and smoking habit were recorded by questionnaire, and ventilatory function, peak flow variability, and bronchial reactivity to inhaled methacholine were measured. Subjects who had asthma in chil dhood were more likely to wheeze (odds ratio [OR] 14.4) or produce phl egm (OR 3.3) than comparison subjects. They also had significantly low er FEV(1) values and greater bronchial reactivity than comparison subj ects. Adult FEV(1) correlated with childhood FEV(1) (both expressed as % of predicted) (r = 0.44, p < 0.01). The prognosis for those childre n who were classed as having wheeze in the presence of infection in 19 64 was better than for those who had asthma. Although they also were m ore likely to report wheeze (OR 3.8) or phlegm (OR 4.4) than compariso n subjects, the wheezy symptoms were unlikely to interfere with activi ties and the ventilatory function and bronchial reactivity to methacho line did not differ from those of comparison subjects. Smokers were mo re likely to report wheeze (OR 2.0), cough (OR 72), and phlegm (OR 3.1 ) than never-smokers, and current smokers with current wheezy symptoms had significantly reduced FEV(1) values, although smoking was not ass ociated with increased methacholine reactivity. The proportion of subj ects who had bronchial hyperreactivity as indicated by a positive PD20 result was greatest in those subjects from the asthma group who had p ersistent symptoms (88%) but was also greater in asymptomatic subjects from the asthma group (42%) than in asymptomatic subjects from the co mparison group (12.8%) (p < 0.01). Gender had no effect on outcome in relation to symptoms but affected reactivity to inhaled methacholine, females having greater bronchial reactivity than males.