Which early childhood factors may increase the risk for pediatric asthma?

Updated: Jan 08, 2019
  • Author: Girish D Sharma, MD, FCCP, FAAP; Chief Editor: Kenan Haver, MD  more...
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A 2012 study reported a significant association between lung function deficit and bronchial responsiveness in the neonatal period with development of asthma by age seven years. [19]

Lemanske et al reported that wheezing illnesses caused by rhinovirus infection during infancy were the strongest predictor of wheezing in the third year of life. [20]

In a study of preschool children with asthma, Guilbert et al found that 2 years of inhaled corticosteroid therapy did not change the asthma symptoms or lung function during a third, treatment-free year. This suggests that no disease-modifying effect of inhaled corticosteroids is present after the treatment is discontinued. [21]

In a study of children in the Cincinnati area, Reponen et al found that a high Environmental Relative Moldiness Index (ERMI) [22] at age 1 year made asthma at age 7 years more likely. The ERMI did not predict specific mold allergies at age 7 years. Air conditioning made asthma less likely. An elevated ERMI at age 7 years had no correlation with current asthma. Seeing or smelling mold in a home inspection at age 1 year did not correlate with the ERMI or with the development of asthma. They also found that black race, having a parent with asthma, and house dust allergy was predictive of a greater likelihood of asthma. [23]

A recent study from Australia reported that obesity is a determinant of asthma control independent of inflammation, lung function, and airway hyperresponsiveness. [24] A similar association between increased risk of worse asthma control and obesity was reported in a recent retrospective study of 32,321 children aged 5-17 years. [25]

A significant inverse relationship between serum vitamin D levels and patient IgE levels, steroid requirements, and in vitro responsiveness to corticosteroids in children has been reported. [26]

Parental cigarette smoking has been shown to increase the likelihood of asthma. This is more true for maternal smoking, though the authors of one study did not correct for primary caretakers. The more cigarettes the mother smoked, the greater the risk of asthma. [27]

A randomized clinical trial by Sheehan et al evaluated the association in children between frequent acetaminophen use and asthma-related complications. The study found that among young children with mild persistent asthma, as-needed use of acetaminophen was not shown to be associated with a higher incidence of asthma exacerbations or worse asthma control than was as-needed use of ibuprofen. [28, 29]

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