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We know very little about the root causes of wheeze in young children. But there's some evidence that bacterial infection could be a trigger. When Danish researchers cultured hypopharyngeal aspirates from a cohort of small babies, they found a clear association between bacterial colonisation and development of wheeze up to the age of 5. The one in five infants colonised with Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis at 1 month of age were more likely to develop persistent wheeze than uncolonised infants (hazard ratio 2.40, 95% CI 1.45 to 3.99), more likely to be admitted to hospital for wheeze (3.85, 1.90 to 7.79), and more likely to have at least one acute severe exacerbation of wheeze (2.99, 1.66 to 5.39). They were also more likely to have a diagnosis of asthma at 4 or 5 years of age.
It is possible that early colonisation of the airway begins a pathological process that leads to wheezing and ultimately asthma, says an editorial (p 1545). But the author believes a more likely explanation is that affected infants had an immune deficiency predisposing them to both atopic wheezing and to early bacterial colonisation. The two could simply coexist because of a common cause.