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Thorax. 2018 Nov;73(11):1049-1061. doi: 10.1136/thoraxjnl-2016-209429. Epub 2018 May 10.

Prevalence estimates and risk factors for early childhood wheeze across Europe: the EuroPrevall birth cohort.

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Clinical and Experimental Sciences and Human Development and Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK.
Department of Paediatrics, Royal Hampshire County Hospital, Winchester, UK.
Department of Nutrition and Dietetics, Southampton Children's Hospital, Southampton, UK.
Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK.
Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Centre, Berlin, Germany.
Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-Universitat Wurzburg, Wurzburg, Germany.
Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Department for Dermatology, Venerology and Allergology, Charité University Medical Centre, Berlin, Germany.
Children's Hospital, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Division of Allergy, Ospedale Pediatrico Bambino Gesu, Roma, Italy.
Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, Lodz, Poland.
Allergy Unit, 2nd Paediatric Clinic, University of Athens, Athens, Greece.
Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK.
Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain.
Department of Immunology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
Department of Pediatric Pulmonology and Allergology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands.
Institute of Inflammation and Repair, Manchester Academic Health Science Centre, Manchester Institute of Biotechnology, University of Manchester, Manchester, UK.
Department of Paediatric Pulmonology and Immunology, Charité University Medical Centre, Berlin, Germany.
NIHR Southampton Respiratory Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.



Preschool wheeze is an important problem worldwide. No comparative population-based studies covering different countries have previously been undertaken.


To assess the prevalence of early childhood wheeze across Europe and evaluate risk factors focusing on food allergy, breast feeding and smoke exposure.


Infants from nine countries were recruited into the EuroPrevall birth cohort. At 12 and 24 months, data on wheeze, allergic signs/symptoms, feeding, smoke exposure, infections and day care attendance were collected using questionnaires. Poisson regression was used to assess risk factors for wheeze.


12 049 infants were recruited. Data from the second year of life were available in 8805 (73.1%). The prevalence of wheeze in the second year of life ranged from <2% in Lodz (Poland) and Vilnius (Lithuania) to 13.1% (95% CI 10.7% to 15.5%) in Southampton (UK) and 17.2% (95% CI 15.0% 19.5%) in Reykjavik (Iceland). In multivariable analysis, frequent lower respiratory tract infections in the first and second years of life (incidence rate ratio (IRR) 1.9 (95% CI 1.3 to 2.6) and 2.5 (95% CI 1.9 to3.4), respectively), postnatal maternal smoking (IRR 1.6, 95% CI 1.1 to 2.4), day care attendance (IRR 1.6, 95% CI 1.1 to 2.5) and male gender (IRR 1.3, 95% CI 1.0 to 1.7) were associated with wheeze. The strength of their association with wheeze differed between countries. Food allergy and breast feeding were not independently associated with wheeze.


The prevalence of early childhood wheeze varied considerably across Europe. Lower respiratory tract infections, day care attendance, postnatal smoke exposure and male gender are important risk factors. Further research is needed to identify additional modifiable risk factors that may differ between countries.


asthma epidemiology; paediatric asthma

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Conflict of interest statement

Competing interests: GR received grants from the EU FP6 Programme and UK Food Standards Agency during the conduct of the study; KEG has received educational grants from Nutrica and speaker fees from Nutrica and Abbott; TK has received grants from the EU FP7 Programme outside of the submitted work; STS received grants from Landspitali University Hospital Science Fund, GlaxoSmithKline and the Icelandic Student Innovation Fund during the conduct of the study and has received non-financial support from Novartis and Thermo Fisher outside of the submitted work; ENCM has received grants from the UK Biological and Biotechnological Sciences Research Council, DBV Technologies, Reacta Biotech Ltd, the Medical Research Council, Innovate and the North West Lung Centre Charity outside of the submitted work and is founding director of Reacta Biotech Ltd; KB has received funding for research activities from the European Union, German Research Foundation, Berliner Sparkasse, BEA-Stiftung, Food Allergy and Anaphylaxis Network, Food Allergy Initiative, Danone, Thermo Fisher and DST Diagnostics. Other authors have no competing interests to declare.

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