Environmental Exposures Associated with Early Childhood Recurrent Wheezing in the Mother and Child in the Environment Birth Cohort: a Time-to-event Study

Overview

Journal Thorax

Date 2024 Jul 4

PMID 38964859

Authors

Kareshma Asharam

Aweke A Abebaw Mitku

Lisa Ramsay

Prakash Mohan Jeena

Rajen N Naidoo

Affiliations

Soon will be listed here.

Abstract

Background: Antenatal factors and environmental exposures contribute to recurrent wheezing in early childhood.

Aim: To identify antenatal and environmental factors associated with recurrent wheezing in children from birth to 48 months in the mother and child in the environment cohort, using time-to-event analysis.

Method: Maternal interviews were administered during pregnancy and postnatally and children were followed up from birth to 48 months (May 2013-October 2019). Hybrid land-use regression and dispersion modelling described residential antenatal exposure to nitrogen dioxide (NO) and particulate matter of 2.5 µm diameter (PM). Wheezing status was assessed by a clinician. The Kaplan-Meier hazard function and Cox-proportional hazard models provided estimates of risk, adjusting for exposure to environmental tobacco smoke (ETS), maternal smoking, biomass fuel use and indoor environmental factors.

Results: Among 520 mother-child pairs, 85 (16%) children, had a single wheeze episode and 57 (11%) had recurrent wheeze. Time to recurrent wheeze (42.9 months) and single wheeze (37.8 months) among children exposed to biomass cooking fuels was significantly shorter compared with children with mothers using electricity (45.9 and 38.9 months, respectively (p=0.03)). Children with mothers exposed to antenatal ETS were 3.8 times more likely to have had recurrent wheeze compared with those not exposed (adjusted HR 3.8, 95% CI 1.3 to 10.7). Mean birth month NO was significantly higher among the recurrent wheeze category compared with those without wheeze. NO and PM were associated with a 2%-4% adjusted increased wheezing risk.

Conclusion: Control of exposure to ETS and biomass fuels in the antenatal period is likely to delay the onset of recurrent wheeze in children from birth to 48 months.

References

Rivera Rivera N, Tamayo-Ortiz M, Mercado Garcia A, Just A, Kloog I, Maria Tellez-Rojo M . Prenatal and early life exposure to particulate matter, environmental tobacco smoke and respiratory symptoms in Mexican children. Environ Res. 2020; 192:110365. PMC: 7736115. DOI: 10.1016/j.envres.2020.110365. View

Rodriguez-Martinez C, Sossa-Briceno M, Castro-Rodriguez J . Factors predicting persistence of early wheezing through childhood and adolescence: a systematic review of the literature. J Asthma Allergy. 2017; 10:83-98. PMC: 5376126. DOI: 10.2147/JAA.S128319. View

Deng Q, Lu C, Li Y, Sundell J, Norback D . Exposure to outdoor air pollution during trimesters of pregnancy and childhood asthma, allergic rhinitis, and eczema. Environ Res. 2016; 150:119-127. DOI: 10.1016/j.envres.2016.05.050. View

Veras M, de Oliveira Alves N, Fajersztajn L, Saldiva P . Before the first breath: prenatal exposures to air pollution and lung development. Cell Tissue Res. 2016; 367(3):445-455. DOI: 10.1007/s00441-016-2509-4. View

Lall O, Bowatte G, Dharmaratne S, Lowe A, Vakalopoulos A, Ambrose I . Household use of biomass fuel, especially traditional stove is associated with childhood wheeze and eczema: a cross sectional study of rural communities in Kandy, Sri Lanka. J Asthma. 2022; 60(2):235-243. DOI: 10.1080/02770903.2022.2043360. View

Zar H, Ferkol T . The global burden of respiratory disease-impact on child health. Pediatr Pulmonol. 2014; 49(5):430-4. DOI: 10.1002/ppul.23030. View

Mallol J, Garcia-Marcos L, Sole D, Brand P . International prevalence of recurrent wheezing during the first year of life: variability, treatment patterns and use of health resources. Thorax. 2010; 65(11):1004-9. DOI: 10.1136/thx.2009.115188. View

Sedgwick P, Joekes K . Interpreting hazard ratios. BMJ. 2015; 351:h4631. DOI: 10.1136/bmj.h4631. View

Kwong C, Bacharier L . Phenotypes of wheezing and asthma in preschool children. Curr Opin Allergy Clin Immunol. 2019; 19(2):148-153. PMC: 6395501. DOI: 10.1097/ACI.0000000000000516. View

10.

Jeena P, Asharam K, Mitku A, Naidoo P, Naidoo R . Maternal demographic and antenatal factors, low birth weight and preterm birth: findings from the mother and child in the environment (MACE) birth cohort, Durban, South Africa. BMC Pregnancy Childbirth. 2020; 20(1):628. PMC: 7574237. DOI: 10.1186/s12884-020-03328-6. View

11.

Sonnenschein-van der Voort A, de Kluizenaar Y, Jaddoe V, Gabriele C, Raat H, Moll H . Air pollution, fetal and infant tobacco smoke exposure, and wheezing in preschool children: a population-based prospective birth cohort. Environ Health. 2012; 11:91. PMC: 3533997. DOI: 10.1186/1476-069X-11-91. View

12.

Thacher J, Emmelin A, Madaki A, Thacher T . Biomass fuel use and the risk of asthma in Nigerian children. Respir Med. 2013; 107(12):1845-51. DOI: 10.1016/j.rmed.2013.09.009. View

13.

Burke H, Leonardi-Bee J, Hashim A, Pine-Abata H, Chen Y, Cook D . Prenatal and passive smoke exposure and incidence of asthma and wheeze: systematic review and meta-analysis. Pediatrics. 2012; 129(4):735-44. DOI: 10.1542/peds.2011-2196. View

14.

Gray D, Willemse L, Visagie A, Czovek D, Nduru P, Vanker A . Determinants of early-life lung function in African infants. Thorax. 2016; 72(5):445-450. PMC: 5520243. DOI: 10.1136/thoraxjnl-2015-207401. View

15.

Gauderman W, Urman R, Avol E, Berhane K, McConnell R, Rappaport E . Association of improved air quality with lung development in children. N Engl J Med. 2015; 372(10):905-13. PMC: 4430551. DOI: 10.1056/NEJMoa1414123. View

16.

Lupu V, Miron I, Lupu A, Moscalu M, Mitrofan E, Munteanu D . The relationship between gastroesophageal reflux disease and recurrent wheezing in children. Medicine (Baltimore). 2021; 100(47):e27660. PMC: 8615307. DOI: 10.1097/MD.0000000000027660. View

17.

Tenero L, Piazza M, Piacentini G . Recurrent wheezing in children. Transl Pediatr. 2016; 5(1):31-6. PMC: 4729036. DOI: 10.3978/j.issn.2224-4336.2015.12.01. View

18.

Alvarez-Alvarez I, Niu H, Guillen-Grima F, Aguinaga-Ontoso I . Meta-analysis of prevalence of wheezing and recurrent wheezing in infants. Allergol Immunopathol (Madr). 2016; 46(3):210-217. DOI: 10.1016/j.aller.2016.08.011. View

19.

Le Roux D, Myer L, Nicol M, Zar H . Incidence and severity of childhood pneumonia in the first year of life in a South African birth cohort: the Drakenstein Child Health Study. Lancet Glob Health. 2015; 3(2):e95-e103. DOI: 10.1016/S2214-109X(14)70360-2. View

20.

Asher M, Rutter C, Bissell K, Chiang C, El Sony A, Ellwood E . Worldwide trends in the burden of asthma symptoms in school-aged children: Global Asthma Network Phase I cross-sectional study. Lancet. 2021; 398(10311):1569-1580. PMC: 8573635. DOI: 10.1016/S0140-6736(21)01450-1. View