Prognosis in preschool children presenting to the pediatric emergency department with wheezing in the previous year

Objective: Wheezing is a significant symptom that is prevalent in preschool childhood and a precursor of asthma. This study aims to investigate the prognosis of wheezing in preschool children admitted to the pediatric emergency department with wheezing in the previous year and to identify the risk factors for wheezing in two consecutive years. Material and Method: The study group consisted of 199 children admitted to Çukurova University Balcalı Hospital Pediatric Emergency Department with wheezing between November 2018 and April 2020. The second year of the study was completed with 132 out of 199 patients presenting to the same department with wheezing in the previous year. In the form prepared to be utilized in the follow-up of the patients, socioeconomic factors such as gender, date of birth and application, presenting symptoms, perinatal and early childhood risk factors, environmental factors, parental education level, monthly household income level, the number of people living at home, and also wheezing and family history, modified ISAAC questions for atopic predisposition, physical examination findings, attack severity score, and laboratory findings, if available. Nasopharyngeal swabs were taken from patients who presented with a wheezing episode. The presence of respiratory syncytial virus (RSV), rhinovirus (RV), influenza A and B, human metapneumovirus (HMPV), human coronavirus (HCoV), and human parainfluenza virus (HPIV) from the samples taken were investigated using PCR tests in the Virology Laboratory. The findings obtained from patients were evaluated both in general and comparatively with group consisted by separating those predisposed to atopy. In order to predict the development of asthma in the patients included in the study, a group was formed that included patients who experienced any of the symptoms such as having 'four or more' wheezing episodes in the last year, having shortness of breath 'always' during the attack, or having an attack that wakes the patient up 'once or more a week', and this group was named 'asthma predictive finding (APF)'. The comparison of the data collected from the patients with and without these complaints was conducted. The data were statistically examined using the IBM SPSS Statistics Version 20.0 package software. Numerical measurements were addressed as mean and standard deviation (median and minimum-maximum where necessary), whereas categorical measurements were coded as numbers and percentages. In order to compare categorical measures between groups, chisquare test statistics was used. In the comparison of numerical measurements between the groups, the T-test was used in independent groups if the hypotheses were validated, and the Mann Whitney U test was used if the hypotheses were not validated. The statistical significance level was taken as 0.05 in all the tests. Results: There were 132 patients in the study, 79 of whom (59.8 %) were males. There were a total of 31 patients, 22 (71 %) men, in the group, which consisted of patients with atopy, and a total of 41 patients, 30 (73.2 %) men, in the group with asthma predictive findings (APF). The virus was detected in 85 (64.4 %) of our 132 patients included in the study (most commonly RV, RSV, Influenza A, HCoV, HPIV, HMPV and influenza B), and it was observed that 53 (62.4 %) of those with the virus had recurrent wheezing symptoms at their admission. It was determined that 17 (32.1 %) of the patients with recurrent wheezing had 4 or more wheezing episodes in the second follow-up year. Considering the virus distributions in these patients with four or more attacks, it was observed that RV is the most prevalent, followed by HPIV, RSV, Influenza A, HMPV and HCoV. Dual infection was detected in 7 (41.1 %) patients, while multiple infections were detected in 1 (5.8 %) patient. It was found that the most common virus was RV, followed by RSV, HPIV, and Influenza A in 9 patients who had 4 or more wheezing episodes for two consecutive years (two consecutive studies). There was a concomitant chronic disease in 30 (73.2 %) patients with APF, a history of hospitalization in the last year in 25 (61 %) patients, and atopy in 18 (43.9 %) patients. Conclusion: The findings indicated that having RV, RSV and HMPV bronchiolitis is a significant risk factor for the recurrence of wheezing episodes in the following year. It might be crucial for the development of asthma. This study determined some other factors that increased APF such as an underlying chronic disease, hospitalization with lower respiratory tract infections in the last year, and having atopic predisposition or respiratory atopic disease. Considering the factors associated with wheezing at least once in preschool age, it was determined that breastfeeding for less than three months and the presence of eczema, smoking during pregnancy, presence of rhinitis in the mother and/or father, parent education level, number of people in the house and number of siblings did not affect the first episode. However, it was found that the main risk factor shortening the time to the first wheezing episode was having a cold in the first 3 months of life. Keywords: Asthma, Risk Factors, Respiratory Tract Virus, Wheezing