By Julia Cruz, Beth Israel Deaconess Medical Center Correspondent

The warm and sunny days of summer are the perfect time for everyone to get outside and get active – riding bicycles, playing sports, or just frolicking at the beach. But for children who suffer from asthma, even summer fun and games can be a challenge.

(credit: iStockphoto)

(credit: iStockphoto)

Asthma is a disease of the lungs that causes the airways to swell, tighten and produce excess mucus. It affects millions of children under the age of 18, some as young as 3, often making the simple act of breathing a chore. Chronic asthma can limit physical activities and keep kids from just being kids.

But what about children younger than 3? Is it possible for infants to suffer from asthma?

“Cough and wheezing in infants is usually due to respiratory infections that cause inflammation in the small airways, rather than asthma,” notes Dr. Douglas Beach, Clinical Director of Pulmonary Medicine at Beth Israel Deaconess Medical Center. “If children continue coughing and wheezing during infancy and as young children, asthma should be considered.”

Now new research finds infants who receive antibiotics before their first birthday may be at greater risk for getting asthma later in childhood.

The study, published in The Lancet Respiratory Medicine, followed more than 1,000 children from birth to 11 years, reviewing medical charts for information about antibiotic prescriptions, and how often the children suffered from exacerbated asthma and wheezing episodes.

Researchers also performed skin tests 4 separate times over the course of the study to see if children had other allergies that could contribute to asthma symptoms as well as genetic testing and blood tests to compare immune system responses between children who took antibiotics in the first year of life, and those who did not.

The research team found infants who were treated with antibiotics before their first birthday were more than twice as likely to develop asthma flare-ups or severe wheezing problems compared to children who were not treated with antibiotics during their first year. The infants who took antibiotics also had lower levels of important proteins, called cytokines, which help fight infection. Genetic testing uncovered two genes that were linked to increased antibiotic prescription in early life.

“Whether this particular genetic trait is associated with increased risk of asthma needs to be further studied,” says Dr. Beach. The evidence from this paper suggests that infants who have a particular genetic variant may be susceptible to viral infections due to decreased levels of important components of the immune system to ward off viral infections. These viral infections may cause wheezing and other respiratory symptoms that are inappropriately treated with antibiotics. The decreased levels of cytokines may increase the risk of viral infections.

“My feeling is that this study most likely identified a genetic predisposition to viral infections that leads to unnecessary use of antibiotics, which puts children at risk for resistant infections. Up to 2 million antibiotic resistant infections occur every year in the United States,” he explains.

Still, Dr. Beach stresses that if a pediatrician feels a bacterial infection is the cause of an infant’s symptoms, antibiotics are very safe and can be used appropriately.

“The most important factors that will reduce the chances of young children developing asthma are to help children avoid triggers to asthma, such as exposure to second hand smoke, dust, and cockroaches,” Dr. Beach advises.

For more information on BIDMC’s Asthma and Dyspnea Center, click here.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted July 2014