Allergy Asthma Immunol Res.  2016 Jan;8(1):22-31. 10.4168/aair.2016.8.1.22.

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

• Mallol J
• Sole D
• Garcia-Marcos L
• Rosario N
• Aguirre V
• Chong H
• Urrutia-Pereira M
• Szulman G
• Niederbacher J
• Arruda-Chavez E
• Toledo E
• Sanchez L
• Pinchak C
• EISL Latin American Group

• KMID: 2166646
• DOI: http://doi.org/10.4168/aair.2016.8.1.22

Abstract

PURPOSE
This study aimed to determine the prevalence and severity of recurrent wheezing (RW) defined as > or =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 > or =4 times mainly for common colds, wheezing, and pharyngitis, and 57.5% paracetamol > or =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.

Keyword

Asthma; respiratory sounds; recurrent wheezing; antibiotics; prevalence; epidemiology

MeSH Terms

Acetaminophen
Adrenal Cortex Hormones
Anti-Bacterial Agents
Asthma
Brazil
Chile
Colombia
Common Cold
Cross-Sectional Studies*
Emergency Service, Hospital
Epidemiology
Family Characteristics
Humans
Infant*
Male
Parents
Peru
Pharyngitis
Pneumonia
Pregnancy
Prescriptions
Prevalence*
Respiratory Sounds*
Risk Factors
Schools, Nursery
Smoking
Acetaminophen
Adrenal Cortex Hormones
Anti-Bacterial Agents

Figure

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  Fig. 1 Frequency of the prescription of antibiotics (ATB) to infants during the first year of life in the whole sample by center.

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  Fig. 2 Frequency of the prescription of antibiotics (ATB) to infants with recurrent wheezing (RW) during the first year of life, by center.

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  Fig. 3 Proportion of infants (%) who received antibiotics (ATB) ≥4 times by indications during the first year of life in the whole sample and infants with recurrent wheezing (RW).

• 

  Fig. 4 Proportion of infants who received paracetamol (PCM) ≥7 times per year during the first year of life in the whole sample and infants with recurrent wheezing (RW) by center.

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