Risk factors for acute wheeze in preschool children: a population-based cohort study

<bold>Background:</bold> Acute wheezing attacks are extremely common in preschool children, but there is limited evidence to inform risk prediction and treatment decisions at this age. <bold>Aim:</bold> To determine clinical and demographic factors associated with recurrent attacks of acute wheeze in preschool children. <bold>Methods:</bold> In this retrospective cohort study, English electronic health data from the Clinical Practice Research Datalink and Hospital Episode Statistics were used to identify children with at least one acute wheezing (index) episode (defined using clinical codes) between 2013-2014. Multivariable logistic regression analyses were performed to explore factors associated with further healthcare presentations with acute wheeze/asthma within 12 months of index presentation. <bold>Results:</bold> 42,820 children aged 5-years or under were included. Almost 40% (16,962/42,820) had a further attack within 12 months. The strongest predictors were hospitalisation at index episode (OR 1.87; 95%CI 1.79 to 1.96) and an attack in the previous year (1.56; 1.44 to 1.70). Male sex (OR 1.09; 95%CI 1.05 to 1.14), South Asian ethnicity (1.14; 1.07 to 1.22), atopy (1.39; 1.33 to 1.45), prematurity (1.16; 1.07 to 1.26), increasing reliever prescriptions (1.09; 1.07 to 1.11), number of previous attacks (1.09; 1.07 to 1.11), and previous hospitalisation with wheeze (1.13; 1.04 to 1.23) were also associated with further attacks. Older age at presentation (OR 0.86; 0.84 to 0.87) and number of prescriptions for inhaled corticosteroids (0.92; 0.90 to 0.94) in the previous year were associated with lower odds for further attacks. <bold>Conclusions:</bold> Our findings can be used to aid clinical risk prediction for further attacks of wheeze in preschool children.