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3243710 
Journal Article 
International study of wheezing in infants: risk factors in affluent and non-affluent countries during the first year of life 
Garcia-Marcos, L; Mallol, J; Sole, D; Brand, PLP; Eisl Study Grp 
2010 
1 
Pediatric Allergy and Immunology
ISSN: 0905-6157
EISSN: 1399-3038 
21 
5 
878-888 
WOS:000280200000011 
Risk factors for wheezing during the first year of life (a
major cause of respiratory morbidity worldwide) are poorly known in non-affluent countries. We
studied and compared risk factors in infants living in affluent and non-affluent areas of the
world. A population-based study was carried out in random samples of infants from centres in
Latin America (LA) and Europe (EU). Parents answered validated questionnaires referring to the
first year of their infant's life during routine health visits. Wheezing was stratified into
occasional (1-2 episodes, OW) and recurrent (3 + episodes, RW). Among the 28687 infants included,
the most important independent risk factors for OW and RW (both in LA and in EU) were having a
cold during the first 3 months of life [OR for RW 3.12 (2.60-3.78) and 3.15 (2.51-3.97);
population attributable fraction (PAF) 25.0% and 23.7%]; and attending nursery school [OR for RW
2.50 (2.04-3.08) and 3.09 (2.04-4.67); PAF 7.4% and 20.3%]. Other risk factors were as follows:
male gender, smoking during pregnancy, family history of asthma/rhinitis, and infant eczema.
Breast feeding for > 3 months protected from RW [OR 0.8 (0.71-0.89) in LA and 0.77 (0.63-0.93) in
EU]. University studies of mother protected only in LA [OR for OW 0.85 (0.76-0.95) and for RW
0.80 (0.70-0.90)]. Although most risk factors for wheezing are common in LA and EU; their public
health impact may be quite different. Avoiding nursery schools and smoking in pregnancy,
breastfeeding babies > 3 months, and improving mother's education would have a substantial
impact in lowering its prevalence worldwide. 
wheezing; asthma; infants; epidemiology; estudio internacional de sibilancias en lactantes