The natural history of pre-school respiratory symptoms and their value in predicting asthma in the early school years

To test whether wheeze and cough in pre-school children would predict the presence of asthma later in childhood, a population whose symptoms had been ascertained during the first five years of life were re-sampled when 4-7 years old to measure current symptoms, lung function, atopy, bronchial responsiveness, airway lability and night cough.;Of the pre-school groups, 37.9% of wheezers continued to wheeze. Although 36.8% of the coughers continued to cough, only 7.2% had started wheezing, a similar proportion to that seen in the asymptomatic group (6.7%). Wheezers showed the greater BR (geometric mean 1.9 mg/ml) and the highest atopic prevalence (AP) (43.6%) when compared with the asymptomatic (BR: 3.39mg/ml; AP 23.8%) and cough groups (BR; 2.62mg/ml; AP 26.7%) (p=0.0001 and p=0.006 respectively). Children whose wheeze persisted demonstrated the highest level of bronchial responsiveness, the poorest lung function and a high prevalence of atopy compared to normals. A subgroup analysis of the cohort originally aged 3 years showed that compared to those who had outgrown their wheeze, persistent symptoms appeared more likely if children were premature, wheezed without having colds (Odds ratio (OR)=7.25, p=0.001), had mothers who smoked (OR=6.18, p=0.003), had frequent wheezing episodes (OR=19.50, p=0.001), or had nocturnal worsening of wheeze (OR=4.14, p=0.015). Night cough was associated with colder bedrooms in wheezy children (17.7oC Vs 21.56oC, p=0.0159).;The study showed that fewer than half of pre-school wheezy children continued to wheeze in the early school years but those with persisting wheeze displayed many clinical characteristics consistent with a diagnosis of asthma. Reassuringly few with pre-school cough progressed to develop asthma characterised by wheeze. Patterns of wheeze and other factors easily identified in pre-school children may help to determine the risk of continuing symptoms. The sleeping environment merits further study.