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A2042 - Identification of Wheezing Phenotypes Among Children with Bronchiolitis Constructing New Roadmap for Risk Minimization for Asthma in Adulthood in Developing Countries
Author Block: N. K. Bhatta1, R. R. Singh2, S. Yadav2; 1Pediatrics, BPKIHS, Dharan, Nepal, 2Peditrics, BPKIHS, Dharan, Nepal.
Introduction and Rationale:Many Wheezy childrenduring the first year of life have Bronchiolitis, although only few among them will experience continued wheezing symptoms and Asthma in later childhood. It is important to recognize Phenotypes among them by identifying common, modifiable risk factors within the early life events that could contribute to increased asthma risk in adulthood. In this Hospital based explorative study, we ascertained “Wheezing Phenotypes” among children with Bronchiolitisin an attempt to construct a New Roadmap for Risk Minimization for Asthma in Adulthood in Developing Countries. Methods: Case files of All the Children with admitted with Bronchiolitis during the period of 2 year from 2015-2016 studied in this hospital based explorative studyconducted at Department of Pediatrics at B. P. Koirala Institute of Health Science (BPKIHS), university teaching hospital in Nepal.The detailed socio-demographic data and clinical spectrum were studied to identify common, modifiable risk factors among them that could contribute to a significantly increased asthma risk in adulthood. Basic descriptive statistics were used to analyze the data. Results: 294 children with bronchiolitis aged 1to 30 months were admitted during the study period. 69 % were males. The mean age was 6 months. 251(85%) received an emergency care. 9% needed admission in PICU. 13% had infrequent wheeze, 42 % had transient early wheeze, 18% had late onset wheeze and 27 % among them were classified as having “wheezy phenotypes” because of presence of “Prolonged early and Persistent wheeze”.Wheezy Phenotypes had Preterm Birth (10%), Inadequate Breast feeding (20 %), Siblings with Respiratory Symptom (20%). 38 % children with poor housing conditions and Indoor cooking with exposure to biomass smoke induced pollution presented as Wheezy Phenotypes. Exposure to maternal smoking during pregnancy and after birth and large family size and poor parental educational status were other risk factors for wheezy phenotypes Conclusions: Certain characteristics among children with Bronchiolitis predisposes them to present as “wheezy phenotype”.Identifying them in the trajectory of Bronchiolitis offers opportunities to intervene for primary or secondary prevention of asthma and it has paramount clinical importance. Prolonged early and persistent wheezing among them reflects persistence of developmental airway abnormalities, post-natal allergenic exposures aggravates existing structural airway abnormalities in this phenotypes and serves as a causative factor for subsequent Asthma in Adulthood.A new roadmap for Risk Minimization for Asthma in Adulthood in Developing Countries can be reconstructed by identifying “wheezy phenotype” and adequately managing them.