Long-Term Follow-up of Children Treated in the Emergency Department for the First Wheezing Episode: A 6-Year Cohort

Longitudinal data on recurrent wheezing in children after the first emergency department-treated wheezing (ED-wheezing) encounter is limited, particularly when the first encounter occurs past infancy. The primary objective of this study was to describe the recurrence rate of ED-wheezing in children following an initial ED-wheezing in 2019 (index encounter) over the subsequent 6 years of follow-up. Secondary objectives were to document the proportion of recurrence in 2020 through 2025 and to elucidate clinical and virological factors associated with recurrence.

We conducted an ambispective cohort study in which children with a viral agent identified on multiplex-PCR (PCR) and who experienced first wheezing episode and received nebulized albuterol in the ED were retrospectively identified as the index encounter in 2019 using electronic health record data and ICD-10 codes. Clinical and virological data were documented for the index encounter. Follow-up over 6 years evaluated the proportion of recurrent ED-wheezing treated with albuterol nebulization (REDAN). Multivariable logistic regression and risk ratio analysis were used to identify factors associated with increased odds of recurrence. This study was approved by the IRB.

Among 566 unique children (mean age 37.8 +/- 43 months, 59% boys), 127 (22.8%) experienced 1 or more REDAN and 44 (7.8%) had multiple recurrences. The annual proportion of REDAN declined from 7.6% in 2020 to 2.8% in 2025 at which point the cumulative first REDAN among encounters with rhinovirus/enterovirus (RV/EV) was 20%, mix viruses 20% and among encounters with isolated respiratory syncytial virus (RSV) was only 11%. In multivariable logistic regression analysis, RV/EV infection (adjusted odds ratio [aOR], 1.83; 95% CI, 1.06 – 3.4), prematurity (aOR 1.6; 95% CI, 1.1 – 2.58), and higher eosinophil percent (aOR, per 1% increase, 1.08;95%; CI, 1.00 – 1.17) were independently associated with REDAN. The risk of recurrence was lower among children with isolated RSV compared to non-RSV infection (risk ratio, 0.53; 95% CI, 0.31-0.92).

Approximately 1 in 4 children experienced recurrent ED-treated wheezing. RV/EV, prematurity and higher eosinophil % were associated with recurrence. ED-treated recurrent wheezing is a clinical phenotype that may be helpful in studying recurrent wheezing trajectory in children beyond infancy.