Pre-school wheeze: determinants and health care effects

Abstract

Wheezing illnesses are an important health problem in children and are a threat to the quality of life of children and their families and account for a large number of primary healthcare consultations in the first years of life. Pre-school wheeze is a symptom that can precede the development of childhood asthma; however the majority of children with wheezing illnesses do not experience these symptoms after the age of three years. When a healthy baby is born, it is difficult to predict whether the infant will experience wheezing symptoms and in case of symptoms whether it will also experience asthma during childhood. Identifying determinants associated with wheezing may help predict long-term outcomes and can have consequences for prevention, diagnosis and treatment. In this thesis we showed that accelerated weight gain during the first three months of life, as well as a reduced neonatal compliance are associated with wheezing illnesses during the first five years of life. An increased neonatal resistance is associated with wheezing illnesses only during the first three years of life. Infant wheezing during Human Rhinovirus infections is an important predictor of childhood wheezing; however this appears to be because these children are susceptible for wheezing partly because of a reduced neonatal lung function. Most of the wheezing symptoms are harmless and self-limiting and often not influenced by medication. Nevertheless, as such symptoms can cause great anxiety to parents, the consultation rates, particularly in primary care, are high. As medical treatment for such symptoms is usually ineffective, in many cases doctors can confine to explaining the course and self-limitedness of the symptoms and reassurance of parents. Internet plays an increasing role in providing health care information and parents appear to be frequent internet–users in searching for health information during pregnancy and during the first years of life of their child. One could hypothesize that reliable online health information provides the desired knowledge, reassures parents, and thereby influences health behaviour and health care utilization. We developed an online parent information program about respiratory symptoms in infants and studied in a randomized controlled trial the effect on health care utilisation. Although parents highly appreciate the provided facilities, this personalized e-support program did not reduce health care utilisation. In a qualitative study it was found that parents appear to be in need of information when their child displays symptoms, and because of its easy accessibility internet is a major source of information. However, only the physician can take away the doubts and insecurity and the decision to consult the physician is based on parents’ own sense and internet does not interfere in this.