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ERJ Open Res. 2018 Nov 20;4(4). pii: 00037-2018. doi: 10.1183/23120541.00037-2018. eCollection 2018 Oct.

Dynamics of respiratory symptoms during infancy and associations with wheezing at school age.

Author information

University Children's Hospital Basel (UKBB), Basel, Switzerland.
Paediatric Respiratory Medicine, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
These authors contributed equally.
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Swiss Tropical and Public Health Institute Basel, Basel, Switzerland.
University of Basel, Basel, Switzerland.


Children with frequent respiratory symptoms in infancy have an increased risk for later wheezing, but the association with symptom dynamics is unknown. We developed an observer-independent method to characterise symptom dynamics and tested their association with subsequent respiratory morbidity. In this birth-cohort of healthy neonates, we prospectively assessed weekly respiratory symptoms during infancy, resulting in a time series of 52 symptom scores. For each infant, we calculated the transition probability between two consecutive symptom scores. We used these transition probabilities to construct a Markov matrix, which characterised symptom dynamics quantitatively using an entropy parameter. Using this parameter, we determined phenotypes by hierarchical clustering. We then studied the association between phenotypes and wheezing at 6 years. In 322 children with complete data for symptom scores during infancy (16 864 observations), we identified three dynamic phenotypes. Compared to the low-risk phenotype, the high-risk phenotype, defined by the highest entropy parameter, was associated with an increased risk of wheezing (odds ratio (OR) 3.01, 95% CI 1.15-7.88) at 6 years. In this phenotype, infants were more often male (64%) and had been exposed to environmental tobacco smoke (31%). In addition, more infants had siblings (67%) and attended childcare (38%). We describe a novel method to objectively characterise dynamics of respiratory symptoms in infancy, which helps identify abnormal clinical susceptibility and recovery patterns of infant airways associated with persistent wheezing.

Conflict of interest statement

Conflict of interest: P. Latzin reports receiving personal fees from Vertex, Novartis, Roche, Polyphor, Vifor and Gilead outside the submitted work.

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