Predictors of asthma three years after hospital admission for wheezing in infancy

Objective. To evaluate the influence of early antiinflammatory therapy in t he development of asthma 3 years after hospitalization for wheezing in infa ncy. In addition, the effects of allergic sensitization and respiratory syn cytial virus (RSV) infection on the development of asthma were investigated . Design and Setting. A randomized, controlled follow-up study in a universit y hospital that provides primary hospital care for all pediatric patients i n a defined area. Patients. Eighty-nine infants under 2 years of age who had been hospitalize d for infection associated with wheezing and followed up for 3 years. Intervention. Early antiinflammatory therapy was given for 16 weeks; 29 pat ients received cromolyn sodium and 31 received budesonide. Twenty-nine cont rol patients received no therapy. Outcome Measures. Clinical diagnosis of current asthma, defined as having a t least 3 episodes of physician-diagnosed wheezing and either a wheezing ep isode during the preceding year or ongoing antiinflammatory medication for asthma. Results. Fourteen (48%) patients in the former cromolyn group, 15 (48%) in the former budesonide group, and 16 (55%) in the control group had current asthma. The significant predictors of asthma were age over 12 months (risk ratio [RR] 4.1; 95% confidence interval [CI] = 1.59-10.35), history of whee zing (RR 6.8; CI = 1.35-34.43), and atopic dermatitis on study entry (RR 3. 4; CI = 1.17-9.39). Skin prick test positivity at the age of 16 months sign ificantly predicted asthma (RR 9.5; CI = 2.45-36.72). In addition, all of t he 18 (20%) children sensitized with furred pet developed asthma. RSV ident ification (RR 0.3; CI = 0.08-0.80) and early furred pet contact at home (RR 0.3; CI 0.10-0.79) were associated with the decreased occurrence of asthma . Conclusions. Antiinflammatory therapy for 4 months has no influence on the occurrence of asthma 3 years after wheezing in infancy. Early sensitization to indoor allergens, especially to pets, and atopic dermatitis predict sub sequent development of asthma. RSV infection in wheezing infants may have a better outcome than other infections.