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Long term prognosis in preschool children with wheeze: longitudinal postal questionnaire study 1993-2004

BMJ 2008; 336 doi: (Published 19 June 2008) Cite this as: BMJ 2008;336:1423
  1. Peter I Frank, director1,
  2. Julie A Morris, head of medical statistics2,
  3. Michelle L Hazell, senior research associate1,
  4. Mary F Linehan, senior research associate1,
  5. Timothy L Frank, director1
  1. 1General Practice Research Unit, North West Lung Research Centre, Wythenshawe Hospital, Manchester M23 9LT
  2. 2Department of Medical Statistics, University Hospital of South Manchester NHS Foundation Trust, Manchester
  1. Correspondence to: M L Hazell michelle.hazell{at}
  • Accepted 9 April 2008


Objectives To follow a population of preschool children with and without parent reported wheeze over a period of 6-11 years to determine prognosis and its important predictive factors.

Design Longitudinal series of five postal surveys based on the international study of asthma and allergies in childhood questionnaire carried out between 1993 and 2004.

Setting Two general practice populations, south Manchester.

Participants 628 children aged less than 5 years at recruitment and those with at least six years’ follow-up data.

Main outcome measures Parent completed questionnaire data for respiratory symptoms and associated features.

Results Of 628 children included in the study, 201 (32%) had parent reported wheeze at the first observation (baseline), of whom 27% also reported the symptom on the second occasion (persistent asthma). The only important baseline predictors of persistent asthma were exercise induced wheeze (odds ratio 3.94, 95% confidence interval 1.72 to 9.00) and a history of atopic disorders (4.44, 1.94 to 10.13). The presence of both predictors indicated a likelihood of 53.2% of developing asthma; if only one feature was present this decreased to 17.2%, whereas if neither was present the likelihood was 10.9%. Family history of asthma was not predictive of persistent asthma among children with preschool wheeze.

Conclusion Using two simple predictive factors (baseline parent reported exercise induced wheeze and a history of atopic disorders), it is possible to estimate the likelihood of future asthma in children presenting with preschool wheeze. The absence of baseline exercise induced wheeze and a history of atopic disorders reduces the likelihood of subsequent asthma by a factor of five.


  • We thank the patients and staff at the two general practices for their help and cooperation.

  • Contributors: PIF and TIF conceived and designed the study. JAM and PIF analysed the data. PIF and MLH drafted the article. All authors interpreted the results, critically revised the manuscript, and approved the final version for publication. PIF is guarantor of the paper.

  • Funding: The four surveys were funded by grants from the NHS Executive (RDO/28/1/01), Allen & Hanburys, Manchester airport, and Astra Zeneca. None of the funding bodies had involvement in the data collection or analysis, the preparation of manuscripts or the decision to submit papers for publication.

  • Competing interests: PIF has received fees for attending meetings from GlaxoSmithKline and Merck Sharp & Dohme and funds for research and travel grants from GlaxoSmithKline, Boehringer Ingelheim, and Merck Sharp & Dohme. MLH has received a fee for speaking from Boehringer Ingelheim and travel grants from GlaxoSmithKline, Boehringer Ingelheim, and Merck Sharp & Dohme. MFL has received travel grants from GlaxoSmithKline. TLF has received fees for speaking from GlaxoSmithKline, Boehringer Ingelheim, Schering Plough, Pfizer, and Astra Zeneca; funds for research from GlaxoSmithKline, Boehringer Ingelheim, Merck Sharp & Dohme, and Schering Plough; funds for consultancy from GlaxoSmithKline, Chiesi Pharmaceuticals, and Pharmacia; and travel grants from GlaxoSmithKline, Boehringer Ingelheim, Astra Zeneca, Chiesi Pharmaceuticals, and Merck Sharp & Dohme.

  • Ethical approval: Ethical approval was not required for the first two postal questionnaire surveys. The last two surveys were approved by south Manchester local research ethics committee.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

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