Prevalence, Severity, and Treatment of Recurrent Wheezing During the First Year of Life: A Cross-Sectional Study of 12,405 Latin American Infants

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Abstract

Purpose

This study aimed to determine the prevalence and severity of recurrent wheezing (RW) defined as ≥3 episodes of wheezing, risk factors, and treatments prescribed during the first year of life in Latin American infants.

Methods

In this international, cross-sectional, and community-based study, parents of 12,405 infants from 11 centers in 6 South American countries (Argentina, Brazil, Chile, Colombia, Peru, and Uruguay) completed a questionnaire about wheezing and associated risk/protective factors, asthma medications, and the frequency of and indications for the prescription of antibiotics and paracetamol during the first year of life.

Results

The prevalence of RW was 16.6% (95% CI 16.0-17.3); of the 12,405 infants, 72.7% (95% CI 70.7-74.6) visited the Emergency Department for wheezing, and 29.7% (27.7-31.7) was admitted. Regarding treatment, 49.1% of RW infants received inhaled corticosteroids, 55.7% oral corticosteroids, 26.3% antileukotrienes, 22.9% antibiotics ≥4 times mainly for common colds, wheezing, and pharyngitis, and 57.5% paracetamol ≥4 times. Tobacco smoking during pregnancy, household income per month <1,000 USD, history of parental asthma, male gender, and nursery school attendance were significant risk factors for higher prevalence and severity of RW, whereas breast-feeding for at least 3 months was a significant protective factor. Pneumonia and admissions for pneumonia were significantly higher in infants with RW as compared to the whole sample (3.5-fold and 3.7-fold, respectively).

Conclusions

RW affects 1.6 out of 10 infants during the first year of life, with a high prevalence of severe episodes, frequent visits to the Emergency Department, and frequent admissions for wheezing. Besides the elevated prescription of asthma medications, there is an excessive use of antibiotics and paracetamol in infants with RW and also in the whole sample, which is mainly related to common colds.

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Most cited references 33

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Antibiotic prescribing in ambulatory pediatrics in the United States.

Adam Hersh, Andy Pavia, Steven Shapiro … (2011)

Antibiotics are commonly prescribed for children with conditions for which they provide no benefit, including viral respiratory infections. Broad-spectrum antibiotic use is increasing, which adds unnecessary cost and promotes the development of antibiotic resistance. To provide a nationally representative analysis of antibiotic prescribing in ambulatory pediatrics according to antibiotic classes and diagnostic categories and identify factors associated with broad-spectrum antibiotic prescribing. We used the National Ambulatory and National Hospital Ambulatory Medical Care surveys from 2006 to 2008, which are nationally representative samples of ambulatory care visits in the United States. We estimated the percentage of visits for patients younger than 18 years for whom antibiotics were prescribed according to antibiotic classes, those considered broad-spectrum, and diagnostic categories. We used multivariable logistic regression to identify demographic and clinical factors that were independently associated with broad-spectrum antibiotic prescribing. Antibiotics were prescribed during 21% of pediatric ambulatory visits; 50% were broad-spectrum, most commonly macrolides. Respiratory conditions accounted for >70% of visits in which both antibiotics and broad-spectrum antibiotics were prescribed. Twenty-three percent of the visits in which antibiotics were prescribed were for respiratory conditions for which antibiotics are not clearly indicated, which accounts for >10 million visits annually. Factors independently associated with broad-spectrum antibiotic prescribing included respiratory conditions for which antibiotics are not indicated, younger patients, visits in the South, and private insurance. Broad-spectrum antibiotic prescribing in ambulatory pediatrics is extremely common and frequently inappropriate. These findings can inform the development and implementation of antibiotic stewardship efforts in ambulatory care toward the most important geographic regions, diagnostic conditions, and patient populations.

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Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis.

L M Sande, Paul Nyquist, F. Steiner … (1998)

The spread of antibiotic-resistant bacteria is associated with antibiotic use. Children receive a significant proportion of the antibiotics prescribed each year and represent an important target group for efforts aimed at reducing unnecessary antibiotic use. To evaluate antibiotic-prescribing practices for children younger than 18 years who had received a diagnosis of cold, upper respiratory tract infection (URI), or bronchitis in the United States. Representative national survey of practicing physicians participating in the National Ambulatory Medical Care Survey conducted in 1992 with a response rate of 73%. Office-based physician practices. Physicians completing patient record forms for patients younger than 18 years. Principal diagnoses and antibiotic prescriptions. A total of 531 pediatric office visits were recorded that included a principal diagnosis of cold, URI, or bronchitis. Antibiotics were prescribed to 44% of patients with common colds, 46% with URIs, and 75% with bronchitis. Extrapolating to the United States, 6.5 million prescriptions (12% of all prescriptions for children) were written for children diagnosed as having a URI or nasopharyngitis (common cold), and 4.7 million (9% of all prescriptions for children) were written for children diagnosed as having bronchitis. After controlling for confounding factors, antibiotics were prescribed more often for children aged 5 to 11 years than for younger children (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.13-3.33) and rates were lower for pediatricians than for nonpediatricians (OR, 0.57; 95% CI, 0.35-0.92). Children aged 0 to 4 years received 53% of all antibiotic prescriptions, and otitis media was the most frequent diagnosis for which antibiotics were prescribed (30% of all prescriptions). Antibiotic prescribing for children diagnosed as having colds, URIs, and bronchitis, conditions that typically do not benefit from antibiotics, represents a substantial proportion of total antibiotic prescriptions to children in the United States each year.

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Association between paracetamol use in infancy and childhood, and risk of asthma, rhinoconjunctivitis, and eczema in children aged 6-7 years: analysis from Phase Three of the ISAAC programme.

Richard Beasley, Tadd Clayton, Julian Crane … (2008)

Exposure to paracetamol during intrauterine life, childhood, and adult life may increase the risk of developing asthma. We studied 6-7-year-old children from Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC) programme to investigate the association between paracetamol consumption and asthma. As part of Phase Three of ISAAC, parents or guardians of children aged 6-7 years completed written questionnaires about symptoms of asthma, rhinoconjunctivitis, and eczema, and several risk factors, including the use of paracetamol for fever in the child's first year of life and the frequency of paracetamol use in the past 12 months. The primary outcome variable was the odds ratio (OR) of asthma symptoms in these children associated with the use of paracetamol for fever in the first year of life, as calculated by logistic regression. 205 487 children aged 6-7 years from 73 centres in 31 countries were included in the analysis. In the multivariate analyses, use of paracetamol for fever in the first year of life was associated with an increased risk of asthma symptoms when aged 6-7 years (OR 1.46 [95% CI 1.36-1.56]). Current use of paracetamol was associated with a dose-dependent increased risk of asthma symptoms (1.61 [1.46-1.77] and 3.23 [2.91-3.60] for medium and high use vs no use, respectively). Use of paracetamol was similarly associated with the risk of severe asthma symptoms, with population-attributable risks between 22% and 38%. Paracetamol use, both in the first year of life and in children aged 6-7 years, was also associated with an increased risk of symptoms of rhinoconjunctivitis and eczema. Use of paracetamol in the first year of life and in later childhood, is associated with risk of asthma, rhinoconjunctivitis, and eczema at age 6 to 7 years. We suggest that exposure to paracetamol might be a risk factor for the development of asthma in childhood.

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Author and article information

Journal

Journal ID (nlm-ta): Allergy Asthma Immunol Res

Journal ID (iso-abbrev): Allergy Asthma Immunol Res

Journal ID (publisher-id): AAIR

Title: Allergy, Asthma & Immunology Research

Publisher: The Korean Academy of Asthma, Allergy and Clinical Immunology; The Korean Academy of Pediatric Allergy and Respiratory Disease

ISSN (Print): 2092-7355

ISSN (Electronic): 2092-7363

Publication date (Print): January 2016

Publication date (Electronic): 27 July 2015

Volume: 8

Issue: 1

Pages: 22-31

Affiliations

[1 ]Department of Pediatric Respiratory Medicine, Hospital El Pino, University of Santiago de Chile (USACH), Santiago, Chile.

[2 ]Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.

[3 ]Pediatric Respiratory and Allergy Units, "Virgen de la Arrixaca" University Children's Hospital, University of Murcia, and IMIB Research Institute, Murcia, Spain.

[4 ]Department of Pediatrics, Hospital de Clínicas, Federal University of Paraná (UFPR), Curitiba, Brazil.

[5 ]Pediatric Asthma Prevention Program (PIPA), Uruguaiana, Brazil.

[6 ]Hospital de Niños "Ricardo Gutiérrez", Buenos Aires, Argentina.

[7 ]Escuela de Medicina, Universidad Industrial de Santander, Bucaramanga, Colombia.

[8 ]Section of Allergy and Clinical Immunology, British American Hospital, Lima, Peru.

[9 ]Hospital de Base de São José do Rio Preto, Faculty of Medicine of Sao José do Rio Preto, São Paulo, Brazil.

[10 ]Department of Pediatrics, Federal University of Mato Grosso, Cuiaba, Brazil.

[11 ]Clínica Pediátrica "B". Hospital Pereira Rossell, Facultad Medicina, Universidad de la Republica, Montevideo, Uruguay.

[12 ]EISL Latin American Group (listed at the end of manuscript)

Author notes

Correspondence to: Prof. Javier Mallol, Department of Pediatric Respiratory Medicine, Hospital CRS El Pino, Ave. Alberto Hurtado 13560, Santiago, Chile. Tel: +56-2-25767545; jmallol@ 123456vtr.net

Article

DOI: 10.4168/aair.2016.8.1.22

PMC ID: 4695404

PubMed ID: 26540498

SO-VID: 3300f7b8-8e22-4fa5-9d5a-dfbbea0e010f

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Prevalence, Severity, and Treatment of Recurrent Wheezing During the First Year of Life: A Cross-Sectional Study of 12,405 Latin American Infants

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Abstract

Purpose

Methods

Results

Conclusions

Related collections

European Journal of Microbiology and Immunology

Most cited references 33

Antibiotic prescribing in ambulatory pediatrics in the United States.

Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis.

Association between paracetamol use in infancy and childhood, and risk of asthma, rhinoconjunctivitis, and eczema in children aged 6-7 years: analysis from Phase Three of the ISAAC programme.

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