Meta-analysis of prevalence of wheezing and recurrent wheezing in infants
Main Article Content
Keywords
Epidemiology, Infants, Meta-analysis, Prevalence, Recurrent wheezing, Wheezing
Abstract
Background: Wheezing affects children’s quality of life, and is related with asthma in childhood. Although prevalence of wheezing has been previously studied in several countries, there is no reference of worldwide prevalence in infants. The aim of this meta-analysis is to estimate the prevalence of wheezing and recurrent wheezing in infants aged up to two years, and compare the prevalence across world regions.
Methods: Literature search was conducted in MEDLINE and SCOPUS databases, looking for observational studies published up to June 2016, including as keywords ‘‘prevalence’’ or ‘‘epidemiology’’ combined with ‘‘wheeze’’, ‘‘wheezing’’ or ‘‘asthma symptoms’’ and ‘‘infant’’ or ‘‘preschool’’. Fast*Pro software and random-effects Bayesian model were used. Heterogeneity was estimated using I2 statistic, and sensitivity analyses were performed.
Results: We identified 109 studies after duplicates were removed. After exclusions, 14 studies were included in the meta-analysis. Prevalence of wheezing and recurrent wheezing were 36.06% (95% CI 35.17-36.96), and 17.41% (95% CI 16.74-18.09), respectively. In European countries, prevalence of wheezing was 30.68% (95% CI 28.97-32.45), and 12.35% (95% CI 11.27-13.47) for recurrent wheezing. Prevalence of wheezing and recurrent wheezing in Latin America were higher, 40.55% (95% CI 39.40-41.71), and 19.27% (95% CI 18.44-20.11), respectively. In Africa, prevalence of wheezing was 15.97% (95% CI 14.05-18.00). Low or no heterogeneity was found in all cases.
Conclusions: More than one-third of infants suffer from wheezing and almost one-fifth from recurrent wheezing, being these illnesses especially prevalent in Latin American countries, pointing out an important public health problem.
References
2. Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ, et al. Asthma and wheezing in the first six years of life. N Engl J Med. 1995;332:133-8.
3. Lemanske RF, Jackson DJ, Gangnon RE, Evans MD, Li Z, Shult PA, et al. Rhinovirus illnesses during infancy predict subsequent childhood wheezing. J Allergy Clin Immunol. 2005;116:571-7.
4. Gilliland FD, Li Y-F, Peters JM. Effects of maternal smoking during pregnancy and environmental tobacco smoke on asthma and wheezing in children. Am J Respir Crit Care Med. 2001;163:429-36.
5. Bjerg A, Hedman L, Perzanowski MS, Platts-Mills T, Lundbäck B, Rönmark E. Family history of asthma and atopy: in-depth analyses of the impact on asthma and wheeze in 7- to 8-year-old children. Pediatrics. 2007;120:741-8.
6. Andersen ZJ, Loft S, Ketzel M, Stage M, Scheike T, Hermansen MN, et al. Ambient air pollution triggers wheezing symptoms in infants. Thorax. 2008;63:710-6.
7. Asher MI, Anderson HR, Stewart AW, Crane J. Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC). Eur Respir J. 1998;12:315-35.
8. Pearce N, Aït-Khaled N, Beasley R, Mallol J, Keil U, Mitchell E, et al. Worldwide trends in the prevalence of asthma symptoms: phase III of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax. 2007;62:758-66.
9. Mallol J, Garcia-Marcos L. Estudio Internacional de Sibilancias en Lactantes (EISL) [Internet]; 2016. Available from: www. respirar.org/images/pdf/respirar/eisl visiondeconjunto.pdf
10. Moher D, Liberati A, Tetzlaff J, Altman DG, the PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.
11. National Heart, Lung and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies
[Internet]; 2016. Available from: https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-riskreduction/tools/cohort
12. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557-60.
13. Mallol J, Garcia-Marcos L, Aguirre V, Martinez-Torres A, Perez-Fernandez V, Gallardo A, et al. The International Study of Wheezing in Infants: questionnaire validation. Int Arch Allergy Immunol. 2007;144:44-50.
14. Sunyer J, Mendendez C, Ventura PJ, Aponte JJ, Schellenberg D, Kahigwa E, et al. Prenatal risk factors of wheezing at the age of four years in Tanzania. Thorax. 2001;56:290-5.
15. Chong Neto HJ, Rosario NA, Sole D, Mallol J. Prevalence of recurrent wheezing in infants. J Pediatr (Rio J). 2007;83:357-62.
16. Belyhun Y, Amberbir A, Medhin G, Erko B, Hanlon C, Venn A, et al. Prevalence and risk factors of wheeze and eczema in 1-year-old children: the Butajira birth cohort, Ethiopia. Clin Exp Allergy. 2010;40:619-26.
17. Bueso A, Figueroa M, Cousin L, Hoyos W, Martinez-Torres AE, Mallol J, et al. Poverty-associated risk factors for wheezing in the first year of life in Honduras and El Salvador. Allergol Immunopathol (Madr). 2010;38:203-12.
18. Dela Bianca AC, Wandalsen GF, Mallol J, Sole D. Prevalence and severity of wheezing in the first year of life. J Bras Pneumol. 2010;36:402-9.
19. Visser CAN, Garcia-Marcos L, Eggink J, Brand PLP. Prevalence and risk factors of wheeze in Dutch infants in their first year of life. Pediatr Pulmonol. 2010;45:149-56.
20. Medeiros D, Silva AR, Rizzo JÂ, Sarinho E, Mallol J, Sole D. Prevalence of wheezing and associated risk factors among infants in Recife, Pernambuco State, Brazil. Cad Saude Publ. 2011;27:1551-9.
21. Pellegrini-Belinchon J, Miguel-Miguel G, De Dios-Martin B, Vicente-Galindo E, Lorente-Toledano F, García-Marcos L. Study of wheezing and its risk factors in the first year of life in the Province of Salamanca, Spain. The EISL Study. Allergol Immunopathol (Madr). 2012;40:164-71.
22. Costa Bessa OAA, Leite AJM, Sole D, Mallol J. Prevalence and risk factors associated with wheezing in the first year of life. J Pediatr (Rio J). 2014;90:190-6.
23. Ferreira ICC, Wandalsen NF. Prevalence and severity of wheezing in the first year of life in the city of Santo André, Brazil. Rev Paul Pediatr. 2014;32:164-70.
24. Moraes LSL, Takano OA, Mallol J, Sole D. Prevalence and clinical characteristics of wheezing in children in the first year of life, living in Cuiabá, Mato Grosso, Brazil. Rev Paul Pediatr. 2014;32:313-9.
25. Bercedo-Sanz A, Lastra-Martinez L, Pellegrini-Belinchon J, Vicente-Galindo E, Lorente-Toledano F, Garcia-Marcos L. Wheezing and risk factors in the first year of life in Cantabria, Spain. The EISL study. Allergol Immunopathol (Madr). 2015;43:543-52.
26. Alvarez-Alvarez I, Niu H, Aguinaga-Ontoso I, Guillen-Grima F. Prevalence and risk factors for wheezing in infants in the region of Pamplona, Spain. Allergol Immunopathol (Madr). 2016;44:415-21.
27. Lai CKW, Beasley R, Crane J, Foliaki S, Shah J, Weiland S, et al. Global variation in the prevalence and severity of asthma symptoms: Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax. 2009;64:476-83.
28. Matricardi PM, Illi S, Grüber C, Keil T, Nickel R, Wahn U, et al. Wheezing in childhood: incidence, longitudinal patterns and factors predicting persistence. Eur Respir J. 2008;32: 585-92.
29. Bisgaard H, Szefler S. Prevalence of asthma-like symptoms in young children. Pediatr Pulmonol. 2007;42:723-8.
30. Mallol J, Sole D, Garcia-Marcos L, Rosario N, Aguirre V, Chong H, et al. Prevalence, severity, and treatment of recurrent wheezing during the first year of life: a cross-sectional study of 12,405 Latin American children. Allergy Asthma Immunol Res. 2016;8:22-31.
31. Garcia-Marcos L, Mallol J, Sole D, Brand PLP, the EISL Study Group. International study of wheezing in infants: risk factors in affluent and non-affluent countries during the first year of life. Pediatr Allergy Immunol. 2010;21:878-88.
32. de Meer G, Reijneveld SA, Brunekreef B. Wheeze in children:the impact of parental education on atopic and non-atopic symptoms. Pediatr Allergy Immunol. 2010;21:823-30.
33. Barreto ML, Cunha SS, Fiaccone R, Esquivel R, Amorim LD, Alvim S, et al. Poverty, dirt, infections and non-atopic wheezing in children from a Brazilian urban center. Respir Res. 2010;11:167.
34. Kumar R, Tsai HJ, Hong X, Gignoux C, Pearson C, Ortiz K, et al. African ancestry early life exposures, and respiratory morbidity in early childhood. Clin Exp Allergy. 2012;42:265-74.
35. World Health Organization. WHO Global Urban Ambient Air Pollution Database [Internet]; 2016. Available from: http://www.
who.int/phe/health topics/outdoorair/databases/cities/en/
36. Gauderman WJ, Urman R, Avol E, Berhane K, McConnell R, Rappaport E, et al. Association of improved air quality with lung development in children. N Eng J Med. 2015;372: 905-13.
37. Islam T, Gauderman WJ, Berhane K, McConnell R, Avol E, Peters JM, et al. Relationship between air pollution, lung function and asthma in adolescents. Thorax. 2007;62:957-63.
38. Alcântara-Neves NM, Badaro SJ, dos Santos MCA, Pontes-deCarvalho L, Barreto ML. The presence of serum anti-Ascaris lumbricoides IgE antibodies and of Trichuris trichiura infection are risk factors for wheezing and/or atopy in preschool-aged Brazilian children. Respir Res. 2010;11:114.
39. Scrivener S, Yemaneberhan H, Zebenigus M, Tilahun D, Girma S, Ali S, et al. Independent effects of intestinal parasite infection and domestic allergen exposure on risk of wheeze in Ethiopia: a nested case-control study. Lancet. 2001;358: 1493-9.
40. Dagoye D, Bekele Z, Woldemichael K, Nida H, Yimam M, Hall A, et al. Wheezing, allergy, and parasite infection in children in urban and rural Ethiopia. Am J Respir Crit Care Med. 2003;167:1369-73.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.