Study: Signs of Developing Asthma and Wheeze in Children Can Be Identified Within First Year of Life

Research findings published in The Lancet Digital Health demonstrate that, at a group level, the dynamic host-environment correlation network properties showed an excellent discriminative ability for identifying groups of infants who have subsequent wheeze and asthma. Additionally, the cumulative symptom scores (CSS) had weak sensitivity and specificity to identify individual-level risks.^1,2

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Previously, host and environment early-life risk factors were found to be associated with asthma and wheezing symptoms over time, but the individual contributions were considered small. The investigators assessed whether dynamic interactions of these risk factors with the developing respiratory system in infants are the dominant factor for subsequent asthma and wheezing. Data were collected from health infants from the Basel-Bern Infant Lung Development (BILD) cohort, which included 435 infants aged 0 to 4 weeks who were recruited between January 1, 1999, and December 31, 2012, and replicated the findings in the Protection Against Allergy Study in Rural Environments (PASTURE) cohort, which included 498 infants aged 0 to 12 months recruited between January 1, 2002, and October 31, 2006.²

Exclusion criteria for the BILD cohort in the current study were prematurity (<37 weeks), major birth defects, perinatal disease, and incomplete follow-up period, and PASTURE exclusion criteria included women younger than 18 years of age, a multiple pregnancy, the inclusion of a child’s sibling in the study, no telephone connection to the family, and the family moved during the study’s duration. Outcome groups included subsequent asthma, wheeze, and “healthy.” Additionally, the first outcome was defined as “ever wheezed” between the age of 2 and 6 years, with week-by-week correlations of the determining factors with CSS were calculated from weeks 2 to 52 and weeks 8 to 52 for the BILD and PASTURE cohorts, respectively. Wheeze outcomes at ages 2 through 6 years were compared in 355 infants from the BILD cohort and 437 infants from the PASTURE cohort, and asthma outcomes were analyzed at 6 years of age in a merged cohort of 783 infants.²

The findings demonstrated a weak sensitivity and specificity to identify risks at the individual level. CSS was observed to be significantly different for asthma and wheeze outcomes and became increasingly important during infancy in direct comparison with all determining factors. Additionally, weekly symptoms were tracked for groups of infants and showed a non-linear increase with time. A logistic regression classification had distinguished between the health group and asthma or wheeze groups (AUC: >0.97, p < .0001; CSS association with wheeze BILD: p = .0002; PASTURE: p = .068).²

“Observing this interaction of risk factors in the context of dynamic development over time is a new way of looking at chronic illnesses,” international research committee member Urs Frey, MD, PhD, professor at the University of Basel and University Children’s Hospital Basel, said in a news release. “It’s a nice, practical example of the value of digital health data, which were first quantified mathematically using these kinds of dynamic network analyses.”¹

These findings, according to the investigators, are consistent with 2018 study results that emphasized an importance of the dynamic interactions between risk factors during development, rather than the risk factors themselves. Further, the current study investigators stressed that these results cannot currently be used for early diagnoses of asthma and wheezing in individual children. Additional research and tools are needed to make such diagnoses.^1,2

“With greater amounts of data and machine learning, it would certainly be conceivable to calculate a risk profile for individual children in the future,” said Frey in the news release.¹

REFERENCES

1. University of Basel. Signs of developing asthma are evident in the first year of life. News release. September 25, 2024. Accessed October 1, 2024. https://www.eurekalert.org/news-releases/1059351

2. Nahum U, Gorlanova O, Decrue F, et al. Symptom trajectories in infancy for the prediction of subsequent wheeze and asthma in the BILD and PASTURE cohorts: a dynamic network analysis. Lancet Digit Health. 2024;6(10):E718-E728. doi:10.1016/S2589-7500(24)00147-X