The natural history of asthma and atopic disease in childhood and the risk factors contributing to their development

Abstract

This study represents the 10-year follow-up of the Isle of Wight 1989 Whole Population Birth Cohort. An important objective of this study was to clearly document the prevalence of asthma and atopic disease amongst a population of 10-year old children.

Results identified considerable prevalence for asthma ever, current asthma and current allergies (eczema, rhinitis, urticaria) at 10-years. Phenotypic analysis revealed that a substantial proportion of early life wheezers (40%) were still wheezing at 10-years of age (Persistent Wheezers - PW). Such children typified the diagnosed asthmatic showing high degrees of atopy throughout childhood plus raised total IgE, impaired lung function and increased bronchial hyper-responsiveness (BHR) at 10-years. Furthermore they showed high disease morbidity and treatment needs. Considerable homology was observed between PW and Late Onset Wheezers (LW), who appeared to form a later manifestation of the same 'atopic asthmatic' state. A genetic predisposition for being asthmatic and atopic appeared to be the paramount risk factor for these states. Environmental factors appeared to be of secondary importance with early life smoking exposure, low Social Class and recurrent chest infections being of importance for PW but not LW. By contrast Early Transient Wheezers (ET W) who outgrew their symptoms displayed little evidence of atopy or BHR at 10-years. However they did show evidence of impaired lung function at 10-years which may be an inherent feature of their constitution. Analysis identified that recurrent chest infections, an asthmatic family history and atopic 4-year SPT were predictive of PW rather than ETW in a child wheezing during the first 4-years of life. Using such results it may be possible to target high-asthma risk children for specific early intervention. Risk factor analysis for current asthma, rhinitis and eczema at 10-years confirmed the importance of an inherited predisposition towards atopy for these conditions. The search to further clarify the aetiology of childhood asthma and atopy may therefore benefit from scrutinising the genetic characteristics of these states.

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