Early Respiratory Infections and Asthma Among New York City Head Start Children

Background. Respiratory infections in neonates have been found to predict wheeze among young children. We hypothesized that among preschool children from low-income minority communities in New York City, current asthma would be associated with a history of respiratory infection in the first few months after their birth. Methods. We asked parents of children in New York City Head Start centers (preschool programs for children of low-income families) to respond to a questionnaire covering demographic factors, lifestyle, home environment, and health history, including a detailed history of respiratory conditions. We used logistic regression to model the association of asthma and asthma severity with history of respiratory infections, controlling for gender, ethnicity, family history of asthma, and other factors. Results. Among 1,022 children (mean age 4± 0.6 years) whose parents provided information about their health history, 359 (35%) met our criteria for asthma. Overall, 22% had had a cold by 6 months and 17% an ear infection by 8 months of age. In multivariable models, children with asthma had had more colds (OR = 2.8, 95% confidence interval [CI] 1.4-6.0) and ear infections (OR = 3.4, 95% CI 1.7-6.9) in the past year than other children. Associations of respiratory infections with emergency department use for asthma (as a measure of severity) were similar. In models that did not control for infections in the past year, ages at first cold and first ear infection were associated with asthma and emergency department visits in the past year. Conclusions. In this sample of preschool children, respiratory infections were common and were associated with asthma and health care utilization for asthma exacerbations. If these findings are confirmed, preventive measures among children who develop such infections at a very early age should be explored to help reduce the burden of asthma in this age group.