Wheezing illness in the transition between childhood and early adulthood
Respiratory symptoms, atopy and asthma have been increasing in prevalence for several decades. It seems likely that changes in the environment are responsible for the changes in prevalence of these diseases and current research is largely focused on factors that are associated with wheezing at different ages. In contrast, the transition period between what are perceived as key age groups is less well studied and that between childhood and early adulthood probably the least clear of all. Some factors appear to pre-date conception, others may exert large influences in the pre-natal phase, and all may have varying overlap with others that manifest later in life. We concluded a follow up study across this transition period examining risk factors for changing wheeze status. The original population from which the current study sample was derived, comprised 3406 Aberdeen schoolchildren identified on a random basis in 1989 aged between 8 and 11 years old (Ninan 920). 1407 of these individuals completed a telephone questionnaire in the 1999-2001 study, 711 attended for full hospital assessment and longitudinal lung function data was available in n=234. We examined the contributions of smoking, atopy, prenatal, postnatal, maternal and genetic factors, gender and the effect of hygiene during this period of flux. The 2 major risk factors consisted of atopy and smoking uptake although intrauterine and passive exposure were also important. The balance of atopy and personal smoking altered as adulthood approached, fine-tuned by multiple other “minor risks”. Atopy was seen to give way to predominantly smoking related illness, thus identifying a critical area for intervention with the aim of preventing a considerable proportion of adult onset wheezing illness.