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• Perinatal Events and Asthma by Girish Gupta, Associate Professor, Department of Pediatrics, Pune
  John O Warner
  Published on: 22 March 2016
• Perinatal events & asthma
  Girish Gupta
  Published on: 22 March 2016

• Published on: 22 March 2016

  Perinatal Events and Asthma by Girish Gupta, Associate Professor, Department of Pediatrics, Pune

  • John O Warner, Professor of Child Health

  Dear Editor

  I thank Professor Gupta for his comments.[1]

  My review article concentrated exclusively on the early life origins of asthma which in mid to late childhood is predominantly a disease associated with allergy. Clearly, however, there are a host of other factors which predispose to wheezing illnesses in early life and to non-atopic bronchial hyperresponsiveness. He very rightly points out that th...

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  Dear Editor

  I thank Professor Gupta for his comments.[1]

  My review article concentrated exclusively on the early life origins of asthma which in mid to late childhood is predominantly a disease associated with allergy. Clearly, however, there are a host of other factors which predispose to wheezing illnesses in early life and to non-atopic bronchial hyperresponsiveness. He very rightly points out that these include perinatal issues such as meconium aspiration, milk aspiration, to which I would add chronic lung disease of prematurity.

  It is interesting that the mode of delivery can have a direct impact in influencing the potential for atopy. Thus, caesarean section vs. normal delivery changes the cytokine profiles produced by stimulated cord blood mononuclear cells.[2] This, in turn, influences the expression of allergic disease in the first two years of life. A recent study showed that an additional risk for wheezing in allergic sensitization to food up to 2 years of age was caesarean section delivery.[3]

  There are a range of perinatal factors which increase susceptibility to respiratory symptoms including rhinitis and wheeze, but very different factors affect susceptibility to atopy and subsequent atopic asthma. Thus, for instance, threatened abortions, general anaesthesia at delivery, prematurity, low birth weight and maternal pregnancy smoking are all significantly related to an increased risk of respiratory symptoms even in the absence of upper respiratory infection. However, none of these factors influence atopy which, in turn, is more likely to be affected by factors such as maternal diet and allergen exposure during pregnancy and postnatally.[4]

  In conclusion, therefore, it is most important to discriminate between those risk factors for respiratory symptoms and those for atopic sensitization. In the former, respiratory symptoms tend to subside through childhood while those with atopic sensitization have a consolidation of symptoms and an increased probability of persistence of asthma through to adulthood.

  References:

  (1) Gupta G. Perinatal events & asthma [electronic response to Warner; The early life origins of asthma and related allergic disorders] archdischild.com 2004http://adc.bmjjournals.com/cgi/eletters/archdischild;89/2/97#672

  (2) Brown MA, Rad PY, Halonen MJ. Pediatr. Allergy Immunol. 2003;14:106- 111.

  (3) Negele K, Heinrich J, Borte M, von Berg A, Schaaf B, Lehmann I, Wichmann H-E, Bolte G for the LISA Study Group. Mode of delivery and development of atopic disease during the first 2 years of life. Pediatr. Allergy Immunol. 2004;15:48-54.

  (4) Stazi M-A, Sampogna F, Montagano G, Grandolfo ME, Couilliot M-F, Annesi -Maesano I. Early life factors related to clinical manifestations of atopic disease but not to skin prick test positivity in young children. Pediatr. Allergy Immunol. 2002;13:105-112.

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  Conflict of Interest:
  None declared.

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• Published on: 22 March 2016

  Perinatal events & asthma

  • Girish Gupta, Associate Professor
  • Other Contributors:
    • AFMC, Pune , India 411 040

  Dear Editor

  I read with interest the article of Warner et al.[1] on topic of “The early life origins of asthma and related allergic disorders.” This study has addressed to very important issues which can bring about preventive strategies at various levels of asthma management.

  I would like to address to some of the areas which probably could not get attention in the article. Meconium aspiration syn...

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  Dear Editor

  I read with interest the article of Warner et al.[1] on topic of “The early life origins of asthma and related allergic disorders.” This study has addressed to very important issues which can bring about preventive strategies at various levels of asthma management.

  I would like to address to some of the areas which probably could not get attention in the article. Meconium aspiration syndrome at birth or milk aspirations are also considered as contributory factors in producing long term pulmonary morbidities including airway hyper-responsiveness.[2,3] Therefore, serious perinatal attempt must be made to minimize firstly the foetal distress & in-utero passage of meconium. Secondly, comprehensive and concerted effort must be made to prevent meconium aspiration syndrome so as to prevent development of later pulmonary hyperreactivity. Correct shoulder elevated post feed position will also minimize risk of milk aspiration.

  References

  1. Warner JO The early life origins of asthma and related allergic disorders Archives of Disease in Childhood 2004;89:97-102.

  2. Khan AM, Elidemir O, Epstein CE, Lally KP, Xue H, Blackburn M, Larsen GL, Colasurdo GN Meconium aspiration produces airway hyperresponsiveness and eosinophilic inflammation in a murine model. Am J Physiol Lung Cell Mol Physiol. 2002 Oct;283(4):L785-90.

  3. Janahi IA, Elidemir O, Shardonofsky FR, Abu-Hassan MN, Fan LL, Larsen GL, Blackburn MR, Colasurdo GN. Recurrent milk aspiration produces changes in airway mechanics, lung eosinophilia, and goblet cell hyperplasia in a murine model. Pediatr Res. 2000 Dec;48(6):776-81.

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  Conflict of Interest:
  None declared.

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