Around a third of children under the age of 5 years old experience wheeze, a whistling sound when breathing. that can make them cough or find it hard to breathe. Wheeze in preschool-aged (aged 1-5 years) is rising in the United Kingdom (UK), with the number of children who suffer or die from wheeze attacks higher compared to that in other European countries.
Wheeze is most often brought on by respiratory infections that get better without treatment. However, some children suffer from recurrent wheeze that can last throughout childhood, which can be an indication that the child will develop the common lung disorder asthma. Recurrent wheeze is influenced by the childs genetic vulnerability, respiratory infections and the air quality of their surrounding environment but can be prevented with timely healthcare after the first wheeze attack. Recognising which preschool children are at risk of recurrent wheeze may help general practitioners (GPs) to reduce the risk of severe, and sometimes fatal, attacks.
We will examine how often preschool-aged children who have had their first wheeze attack return to visit their GPs, emergency department or have unplanned hospital admissions for recurrent wheeze. We will examine if preventive and timely healthcare, such as seeing your GP within two days after the initial wheeze attack for an early review, could reduce repeat visits to GPs, emergency department visits and unplanned hospital admissions for wheeze. We will also examine how childrens surrounding environments, such as having a mother who smokes or has asthma, impacts their chance of getting recurrent wheeze.
Reducing the burden of preschool wheeze is a priority for improving child health in the United Kingdom (UK), which has the highest number of children dying from wheeze attacks in Europe. Compared with older children (?5 years), preschool children (aged 1-5 years, up to fifth birth birthday) are at greater risk of wheeze attacks.
In most cases, respiratory wheeze does not require medical treatment, but some preschool children develop recurrent wheeze leading to poor health and frequent use of health care. Recurrent wheeze is influenced by genetic predisposition and exposure to respiratory infections and air quality of their surrounding environment. While studies have reported risk factors for acute asthma attacks in school-aged children, few studies have examined the risk factors for re-admission or future attacks in the preschool population. Recurrent wheeze is potentially preventable through effective primary care following an initial wheeze attack and limiting environmental risk factors such as passive smoke exposure.
Using Poisson regression, we will examine the frequency and timing of recurrent wheeze in preschool children, defined as two or more in the last 12 months, presenting to GPs, emergency departments and resulting in unplanned hospital admission. We will examine the extent to which preventive healthcare, such as developmental reviews and vaccinations, and responsive care including asthma reviews and management plans after the first wheeze attack, impact childrens rates of subsequent wheeze attacks. We will also investigate the extent to which area deprivation, maternal smoking and having a family history of asthma such as maternal asthma diagnosis predicts rates of recurrent wheeze.
Recurrent wheeze:
We will define recurrent wheeze attack as any of the following within 12 months of an initial wheeze attack:
1) GP consultations for wheeze or asthma (Appendix A)
2) ED visits either within 48 hours of a GP consultation for wheeze/asthma or which resulted in treatment with nebulised or inhaled medication.
3) Unplanned hospital admissions with a primary diagnosis of wheezing/asthma within the 12-month-period following initial wheeze attack (Appendix C).
Recurrent wheeze will be categorised by the number of all attendances.
Coding of ED visits is sufficient for events but data quality are insufficient for ICD 10 codes to be relied on for the reason for the visit. Hence we will use this combined approach to identify visits to ED for wheeze. This will miss children who self-refer directly to ED for wheeze or who do not attend their GP in the 48 hours before or after a wheeze episode.
Sonia Saxena - Chief Investigator - Imperial College London
Hanna Creese - Corresponding Applicant - Imperial College London
Alex Bottle - Collaborator - Imperial College London
Dougal Hargreaves - Collaborator - Imperial College London
Jennifer Quint - Collaborator - Imperial College London
Sejal Saglani - Collaborator - Imperial College London
Kimberley Foley - Collaborator - Imperial College London
Mark Cunningham - Collaborator - Imperial College London
CPRD Mother-Baby Link;HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation;CPRD Aurum Mother-Baby Link;CPRD GOLD Mother-Baby Link