title: Incidence and characteristics of early childhood wheezing, Dhaka, Bangladesh, 2004-2010.
abstract: BACKGROUND
  Early childhood wheezing substantially impacts quality of life in high-income countries, but data are sparse on early childhood wheezing in low-income countries. We estimate wheezing incidence, describe wheezing phenotypes, and explore the contribution of respiratory viral illnesses among children aged <5 years in urban Bangladesh.
  
  
  METHODS
  During 2004-2010, respiratory illness surveillance was conducted through weekly home visits. Children with fever or respiratory illness were referred for examination by study physicians including lung auscultation. During 2005-2007, every fifth referred child had nasal washes tested for human metapneumovirus, respiratory syncytial viruses, and influenza and parainfluenza viruses.
  
  
  RESULTS
  During April 2004-July 2010, 23,609 children were enrolled in surveillance. Of these, 11,912 (50%) were male, median age at enrollment was 20 months (IQR 5-38), and 4,711 (20%) had ≥1 wheezing episode accounting for 8,901 episodes (733 [8%] associated with hospitalization); 25% wheezed at <1 year of age. Among children aged <5 years, incidences of wheezing and wheezing hospitalizations were 2,335/10,000 and 192/10,000 child-years. Twenty-eight percent had recurrent wheezing. Recurrent versus non-recurrent wheezing episodes were more likely to be associated with oxygen saturation <93% (OR 6.9, 95%CI 2.8-17.3), increased work of breathing (OR 1.6, 95%CI 1.4-1.8), and hospitalization (OR 2.0, 95%CI 1.6-2.4). Respiratory viruses were detected in 66% (578/873) of episodes with testing.
  
  
  CONCLUSIONS
  In urban Bangladesh, early childhood wheezing is common and largely associated with respiratory virus infections. Recurrent wheezing is associated with more severe illness and may predict children who would benefit most from closer follow-up and targeted interventions. Pediatr Pulmonol. 2016;51:588-595. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta.
authors.forename: Fatimah S
authors.initials: FS
authors.lastname: Dawood
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta.
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Fry
authors.affiliation: International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: Doli
authors.initials: D
authors.lastname: Goswami
authors.affiliation: International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: Amina
authors.initials: A
authors.lastname: Sharmeen
authors.affiliation: International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: Kamrun
authors.initials: K
authors.lastname: Nahar
authors.affiliation: International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: Bilkis Ara
authors.initials: BA
authors.lastname: Anjali
authors.affiliation: International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: Mustafizur
authors.initials: M
authors.lastname: Rahman
authors.affiliation: International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.|The Bloomberg School of Public Health, Johns Hopkins University, Baltimore.
authors.forename: W Abdullah
authors.initials: WA
authors.lastname: Brooks
mesh_terms: D000367:Age Factors; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D001459:Bangladesh / Q000453:epidemiology; D002675:Child, Preschool; D005260:Female; D005334:Fever; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011203:Poverty / Q000706:statistics & numerical data*; D062486:Public Health Surveillance; D011788:Quality of Life; D012135:Respiratory Sounds / Q000209:etiology; D018357:Respiratory Syncytial Virus Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D012141:Respiratory Tract Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D012307:Risk Factors; D014505:Urban Population
keywords: asthma and early wheeze; epidemiology; infections; international health; pneumonia; viral