PREDICTORS OF THE COURSE OF OBSTRUCTIVE A IRWAYS DISORDERS IN CHILDREN - RESULTS OF A FOLLOW-UP-STUDY

A follow-up study was undertaken to determine the predictors of the co urse of recurrent wheezing episodes in children (between 0 to 8 years) . In 1991, 600 children with wheezing episodes had been recorded by ph ysicians who participated in a sentinel practice network. On each cons ultation with the same physicians from October 1994 until June 1995, p arents of these children were questioned again about the course of the ir respiratory symptoms (n = 218). Associations between the course of disease and predictors (recorded by physicians in 1991) were analysed using polytomous logistic regression. The following factors were signi ficantly associated with the frequency of asthmatic episodes (odds rat io (OR) > 1 indicates an unfavourable course of disease in comparison with the reference category, [95% confidence interval]): indoor cigare tte smoking: OR=1.7; [1.0-3.0], older than 1 year of age (reference: < 1 year): OR=3.0; [1.1-8.5], more than 5 asthmatic episodes during the year before the first registration: OR-2.7; [1.3-5.6], infect-associat ed asthma: OR=0.4 [0.2-1.0], paediatrician as recording physician (ref erence: general practitioner): OR=0.4 (0.2-0.8). No significant associ ation with the course of disease was found for sex, education of the p arents, region, parental asthma, hospital admissions because of obstru ctive symptoms. In correspondence with other studies, the majority of children showed a favourable course of their obstructive respiratory s ymptoms: for only 7% the frequency of episodes increased during 3 year s after the first contact. Indoor smoking and severity of asthma are k nown as predictors of the course of the disease. The better prognosis of infect-associated obstructive symptoms supports the thesis that the majority of infants with asthmatic symptoms have narrow, infect-media ted airways obstructions, but no increased risk for bronchial asthma i n their later lives. An early identification of children at risk may a llow a specific and intensified therapy to improve the course of disea se.