Wheezing that begins in early life and continues into the school years generally persists into adulthood. This persistent wheezing is associated with lung function deficits and airways hyperresponsiveness that is established in the first few years of life.
Factors associated with increased risk of persistent wheeze include:
- allergic sensitization early in life
- early-life infection with rhinovirus
- colonization with any of a number of bacteria
Allergic (atopic) march (click here to enlarge the image).
There are 2 windows of vulnerability during a person's lifetime:
1. Early life, whether in utero or in the first few years of life, during which airway injury results in persistent airways dysfunction.
2. Preadolescent and adolescent years.
Modified Asthma Predictive Index (API) (click to enlarge the image).
Lung function growth patterns established by age 6 years continue into adulthood, typically leaving patients with wheezing that persists into or relapses during adulthood with a mean FEV1 10% less than their peers who do not wheeze.
However, a subgroups of patients with persistent asthma have progressive decreases in lung function and enter adulthood with even lower lung function. This group is at risk for the later development of chronic obstructive pulmonary disease (COPD).
Long-term outcomes of early-onset wheeze and asthma. Grad R, Morgan WJ. J Allergy Clin Immunol. 2012 Aug;130(2):299-307. doi: 10.1016/j.jaci.2012.05.022. Epub 2012 Jun 26.