S13 Early Persistent Childhood Wheeze is a Risk for more Troublesome Young Adult Asthma

Background Until recently being a wheezy infant was not felt to confer significant respiratory health risks in later life. Using the Isle of Wight Birth Cohort (IOWBC) we assessed the association of persistent childhood wheeze with young adult lung function, wheezing status/morbidity, allergic comorbidity and smoking. Methods The Isle of Wight Birth Cohort (n = 1,456) was reviewed at 1, 2, 4, 10 and 18-years with recording of current wheeze at each visit. At 10-years, 4 separate childhood wheeze phenotypes were defined. Those who wheezed in the first 4-years of life and at 10-years were labelled Persistent-Wheezers (PW). The outcome of PW was then assessed at 18-years to determine the effects of early life persistent wheeze on adult lung health. Results Wheezing occurred in 57.7% PW at 18-years. Asthma prevalence in PW fell from 76.0% to 58.2% over adolescence and PW comprised 38% of currently diagnosed asthma at 18-years. PW had significantly impaired lung function at 18-years compared to Non-Wheezers (NW) who never wheezed in the 1 st decade of life. This included impaired FEV1, FEV1/FVC ratio and FEF25–75 along with significantly elevated bronchodilator response (BDR), bronchial hyperresponsiveness (BHR), exhaled Nitric Oxide (FeNO) plus significantly reduced gain in FEF 25–75 over adolescence (Table 1). Compared to NW at 18-years, PW were significantly more likely to have atopy, eczema, and rhinitis (Table 1). Of concern, prevalence of current smoking (44.4%) at 18-years was significantly greater in PW than NW as was passive smoke exposure through the life course (Table 1). Discussion Our findings highlight young adult respiratory consequences of PW. While there was some outgrowth of disease over adolescence a considerable proportion of PW showed significant airways disease at 18-years. We previously showed that PW already have impaired lung function by 10-years and these further findings suggest that phenomenon tracks through adolescence with possible additional effects on small airways growth. The longer term consequences of that finding allied to the high smoking prevalence in this phenotype merit attention.