{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T11:54:08Z","timestamp":1773057248401,"version":"3.50.1"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T00:00:00Z","timestamp":1743379200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To study the etiology of recurrent and persistent wheezing in infants and toddlers, and identify the risk factors for infantile asthma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analyzed the data of 612 children (aged 0\u201336 months) hospitalized for recurrent or persistent wheezing between 2019.09.01 and 2022.08.31. We comparatively analyzed their clinical, laboratory, imaging, and lung-examination data between different groups. Multivariate logistic regression analysis was used to identify risk factors for asthma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The etiologies of recurrent and persistent wheezing significantly differed (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05). The top 3 causes of recurrent wheezing were viral infections (48.4%), infantile asthma (28.0%), and protracted bacterial bronchitis (PBB; 9.5%), whereas the top 3 causes of persistent wheezing were PBB (67.5%), tracheomalacia (22.2%), and infantile asthma (15.9%). The distribution of etiologies varied by age. Bronchoscopy was performed for 181 children, and mainly showed purulent changes (34.3%), tracheomalacia (27.1%), and positive pathogenic bronchoalveolar lavage fluid (25.4%). Older age, admission to the intensive care unit (ICU), positive modified Asthma Prediction Index (mAPI), and food allergy were risk factors for asthma. The odds ratio of mAPI was 4.066. The area under the receiver operating characteristic curve of the risk factors for predicting asthma was 0.8016.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Wheezing phenotype and age may partly guide the etiological diagnosis of recurrent\/persistent wheezing in infants and young children. Bronchoscopy is important for the diagnosis of refractory recurrent\/persistent wheezing, while mAPI aids in the diagnosis of asthma. When infants and children with recurrent or persistent wheezing have the characteristics of older age, ICU admission, positive mAPI, and food allergy, the possibility of asthma may be considered.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1521346","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T05:15:32Z","timestamp":1743398132000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["A study of etiology and asthma risks in infants and toddlers hospitalized for recurrent or persistent wheezing"],"prefix":"10.3389","volume":"13","author":[{"given":"Qiuwei","family":"Yi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shanshan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingjing","family":"Qiao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yulan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lu","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuejie","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanmin","family":"Bao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kunling","family":"Shen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"48","DOI":"10.3810\/pgm.2009.09.2052","article-title":"Recurrent wheezing illness in preschool-aged children: assessment and management in primary care practice","volume":"121","author":"Bloomberg","year":"2009","journal-title":"Postgrad Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1067\/mai.2003.162","article-title":"Tucson children\u2019s respiratory study: 1980 to present","volume":"111","author":"Taussig","year":"2003","journal-title":"J Allergy Clin Immunol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"483","DOI":"10.3877\/cma.j.issn.1673-5250.2018.04.018","article-title":"Prevention and treatment of infant wheezing research progress","volume":"14","author":"Zhang","year":"2018","journal-title":"Chin J Matern Child Clin Med (Electron Ed)"},{"key":"B4","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1111\/j.1398-9995.1995.tb01210.x","article-title":"Clinical diagnosis of wheezing in early childhood","volume":"50","author":"Martinati","year":"1995","journal-title":"Allergy"},{"key":"B5","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1164\/rccm.201604-0694ST","article-title":"Official American thoracic society clinical practice guidelines: diagnostic evaluation of infants with recurrent or persistent wheezing","volume":"194","author":"Ren","year":"2016","journal-title":"Am J Respir Crit Care Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1016\/j.aller.2016.08.011","article-title":"Meta-analysis of prevalence of wheezing and recurrent wheezing in infants","volume":"46","author":"Alvarez-Alvarez","year":"2018","journal-title":"Allergol Immunopathol (Madr)"},{"key":"B7","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1056\/nejm199501193320301","article-title":"Asthma and wheezing in the first six years of life. The group health medical associates","volume":"332","author":"Martinez","year":"1995","journal-title":"N Engl J Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1593","DOI":"10.1016\/s0140-6736(14)60615-2","article-title":"Diagnosis, management, and prognosis of preschool wheeze","volume":"383","author":"Ducharme","year":"2014","journal-title":"Lancet"},{"key":"B9","volume-title":"Global Strategy for Asthma Management and Prevention","year":"2019"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1183\/13993003.02139-2016","article-title":"ERS statement on protracted bacterial bronchitis in children","volume":"50","author":"Kantar","year":"2017","journal-title":"Eur Respir J"},{"key":"B11","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1016\/j.alit.2017.02.001","article-title":"Japanese guidelines for food allergy 2017","volume":"66","author":"Ebisawa","year":"2017","journal-title":"Allergol Int"},{"key":"B12","doi-asserted-by":"publisher","first-page":"708","DOI":"10.3760\/cma.j.cn112140-20200604-00578","article-title":"Recommendations for diagnosis and management of bronchial asthma in children. (2020)]","volume":"58","author":"Jianguo","year":"2020","journal-title":"Zhonghua Er Ke Za Zhi"},{"key":"B13","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1016\/j.anai.2018.04.002","article-title":"The pediatric asthma yardstick: practical recommendations for a sustained step-up in asthma therapy for children with inadequately controlled asthma","volume":"120","author":"Chipps","year":"2018","journal-title":"Ann Allergy Asthma Immunol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1002\/ppul.23829","article-title":"Trans-nasal flexible bronchoscopy in wheezing children: diagnostic yield, impact on therapy, and prevalence of laryngeal cleft","volume":"53","author":"Boesch","year":"2018","journal-title":"Pediatr Pulmonol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/medicina56070329","article-title":"Flexible bronchoscopy in evaluation of persistent wheezing in children-experiences from national pediatric center","volume":"56","author":"Sovtic","year":"2020","journal-title":"Medicina (Kaunas)"},{"key":"B16","article-title":"Global Initiative for Asthma(GINA).","year":""},{"key":"B17","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1164\/rccm.200702-212OC","article-title":"Early detection of airway wall remodeling and eosinophilic inflammation in preschool wheezers","volume":"176","author":"Saglani","year":"2007","journal-title":"Am J Respir Crit Care Med"},{"key":"B18","doi-asserted-by":"publisher","first-page":"5026","DOI":"10.1038\/s41467-021-25120-6","article-title":"Etiological and epidemiological features of acute respiratory infections in China","volume":"12","author":"Li","year":"2021","journal-title":"Nat Commun"},{"key":"B19","doi-asserted-by":"publisher","first-page":"800","DOI":"10.7499\/j.issn.1008-8830.2014.08.006","article-title":"Clinical application of tidal breathing lung function test in 1\u20134 years old children with wheezing diseases","volume":"16","author":"Han","year":"2014","journal-title":"Zhongguo Dang Dai Er Ke Za Zhi"},{"key":"B20","doi-asserted-by":"publisher","first-page":"947","DOI":"10.19538\/j.ek2018110615","article-title":"Establishment of diagnostic criteria for asthma in children under 6 years old in China","volume":"36","author":"Yixiao","year":"2021","journal-title":"Chin J Pract Pediatr"},{"key":"B21","doi-asserted-by":"publisher","first-page":"947","DOI":"10.19538\/j.ek2021120614","article-title":"Validation of diagnostic criteria for asthma in children under 6 years old: a multicenter study","volume":"36","author":"Jie","year":"2021","journal-title":"Chin J Pract Pediatr"},{"key":"B22","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1016\/j.jaip.2012.10.008","article-title":"Evaluation of the modified asthma predictive index in high-risk preschool children","volume":"1","author":"Chang","year":"2013","journal-title":"J Allergy Clin Immunol Pract"},{"key":"B23","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1111\/cea.13336","article-title":"Validation of childhood asthma predictive tools: a systematic review","volume":"49","author":"Colicino","year":"2019","journal-title":"Clin Exp Allergy"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1521346\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T05:15:40Z","timestamp":1743398140000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1521346\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,31]]},"references-count":23,"alternative-id":["10.3389\/fped.2025.1521346"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1521346","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,31]]},"article-number":"1521346"}}