ECHO Study Identifies Demographics of Children Most Likely to Develop Asthma

Author(s): Christine Cole Johnson and Aruna Chandran

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

What were the study results?

The study found that children with at least one parent with a history of asthma had two to three times higher rates of asthma. This higher risk with family history of asthma mostly affected younger children, through four years old. The rates for boys went down with age, but rates for girls stayed about the same, so by the teenage years girls developed asthma more often than boys. Black children were diagnosed with asthma more than white children during preschool years, but less than white children after age 9-10 years.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study helps us understand what groups of children are more likely to get asthma. The research shows that young Black children and young children whose parents had asthma develop asthma more often than other groups. Researchers can work to develop new asthma programs to help keep children at highest risk from getting asthma.

Why was this study needed?

Childhood asthma is a major cause of suffering, missed school for children, and missed work for parents. Researchers and doctors need to understand who is more likely to get asthma, not just focus on who already has it, as other studies have done. Knowing this information is a step to finding out why certain kids get asthma and preventing it. Using information from children from diverse backgrounds in the United States, this paper describes which children developed asthma from early childhood through adolescence.

Who was involved?

Children younger than 18 years old taking part in 31 studies within the ECHO program

What happened during the study?

The research team found out the ages when children learned from a doctor they had asthma, and the children’s race, sex, and what state they lived in. It was also important to collect information on whether their parents had asthma or not.

What happens next?

Researchers should work on asthma prevention programs for very young children, especially Black children and those whose parents have had asthma.

Where can I learn more?

If you would like to learn more about asthma in children, please visit the Centers for Disease Control and Prevention or the National Heart Lung and Blood Institute (NHLBI).

Access the full journal article, titled “Childhood Asthma Incidence Rate Patterns from the ECHO Consortium: Identifying High-Risk Groups for Primary Prevention.”

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published: May 17, 2021

Download this summary

ECHO Study Identifies Demographics of Children Most Likely to Develop Asthma

ECHO Study Identifies Genetic Underpinnings of Wheezing Patterns Linked to Asthma

<< Back to Research Summaries

ECHO Study Identifies Genetic Underpinnings of Wheezing Patterns Linked to Asthma

Author(s): Brian Hallmark, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health under Award Number 5UH3 OD023282.

What were the study results?

Four wheezing patterns were seen among the children: (1) infrequent—few wheezing episodes in the first three years then none after that; (2) transient—some wheezing in first few years then fewer and gone by around age six; (3) late onset—little wheezing in the first few years then slowly happens more often; (4) persistent—many wheezing episodes over the first 11 years.

About half of children experience wheezing before three years old, and 62% wheezed in the first 10 years of life. The wheezing may start because of a viral infection (like the common cold). Many children only wheeze as preschoolers. AA children were more likely than European American (EA) children to have persistent wheezing.

Several small gene changes were connected to transient, late onset, and persistent wheezing in EA children, but for both AA and EA children, only two specific small gene changes were connected with a greater likelihood of the child wheezing after the first three years.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

For the first time, it is reported that genetic changes associated with childhood asthma are also associated with all wheezing patterns in young children. These wheezing patterns were found consistently in children located in different cities and born in different decades.

Wheezing in young children is often a result of common respiratory viruses that affect breathing. These findings, together with what we know about the genes associated with asthma, suggest that some of these small gene changes may be connected to a higher risk of colds and other viral airway infections that trigger wheezing in small children.

This study also highlights the importance of including multiple race/ancestry groups in genetic studies to understand how small changes in genes are connected to different health outcomes in diverse groups.

Why was this study needed?

Previous studies have shown that many children wheeze during the first few years of life—some later stop, while others can develop ongoing asthma. Other children do not wheeze during early life but still develop asthma later during childhood. Understanding where these patterns come from may shed light on how asthma begins and help doctors identify children who might need help earlier. Other studies identified small changes in specific genes that could be responsible for some cases of childhood asthma. This study tried to find possible connections between those small gene changes and different wheezing patterns in children. This is also the first study that looks at how small genetic changes may relate to specific patterns of wheezing in African American (AA) children.

Who was involved?

Data came from children enrolled at birth in seven different studies across the US. Nearly 3,700 children who experienced at least three wheezing events were included, and researchers analyzed the genes of 1,928 of these children. About 32% of these children were AA. Each study site used questionnaires and interviews to collect information from children and their parents over many years.

What happened during the study?

The team collected patient characteristics and data on wheezing and asthma and pulled those data together to group each child based on when and how often they wheezed from birth to age 11. Each site also collected DNA samples from the children and sent them to be analyzed for small changes in genes associated with asthma. The researchers used statistics to identify four different wheezing patterns and connect them with specific genetic changes.

What happens next?

The team is looking at possible associations between children’s insulin levels, genetic variations, and the development of asthma in childhood.

Where can I learn more?

Access the full journal article, titled “Chromosome 17q12-21 Variants Are Associated with Multiple Wheezing Phenotypes in Childhood,” in the American Journal of Respiratory and Critical Care Medicine.

Additional Details

This project would not have been possible without ECHO CREW support, as the data came from seven separate birth cohorts brought together by that program. In particular, combining those datasets was essential to getting a large enough sample size to include AA children.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Read the corresponding article.

Published: April 1, 2021

Download this summary

ECHO Study Identifies Genetic Underpinnings of Wheezing Patterns Linked to Asthma

ECHO Study Finds Children Are Less Likely to Get the Common Cold as They Get Older

<< Back to Research Summaries

ECHO Study Finds Children Are Less Likely to Get the Common Cold as They Get Older

Author(s): Timothy Choi, James E. Gern and Yury A. Bochkov

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health. Additional support came from contributing studies by the NIH, the Sigrid Juselius Foundation (Helsinki, Finland) and the National Health Medical Research Council (Australia).

What were the study results?

As children age, they are less likely to be infected with the rhinovirus C species. This may be because the immune system gets stronger against infection with rhinovirus C species compared to other species. Other personal factors related to more frequent infections are wheezing respiratory illnesses and a genetic difference in a protein used by the viruses to enter cells.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health care without first consulting your healthcare professional.

What was the study's impact?

Infections with rhinoviruses, generally known as common colds, are the most common cause of wheezing illnesses in preschoolers and children with asthma. Unfortunately, there are no treatments for these respiratory viruses. The results of the study identify children most likely to develop more severe illnesses with rhinovirus C based on young age and genetics. This new information on at-risk populations and the viruses most likely to cause illnesses can help scientists create a vaccine specifically for the rhinovirus C species.

Why was this study needed?

Rhinovirus is a leading cause of the common cold and wheezing illnesses in young children and in children with asthma. There are three species of rhinoviruses (A, B, and C), and C viruses are often more likely to cause wheezing illnesses, especially in young children. The main objectives of this study were to identify age and other personal risk factors for rhinovirus illnesses, and to determine whether certain rhinoviruses are more frequent and more likely to cause wheezing illnesses.

Who was involved?

More than 4,000 children were enrolled in 14 independent studies across the United States, Finland, and Australia from 2000 to 2019. Study participants had illnesses of varying severity and varied in age from zero to 19 years.

What happened during the study?

Each of the 14 sites collected nasal samples and studied them for rhinovirus species and type. The investigators then tested whether characteristics such as age, gender, and race influenced which viruses were seen. Investigators also identified which viruses are most common and which are most likely to cause illnesses.

What happens next?

Future research will focus on studying the strength and length of time people can be immune to rhinovirus C. This will help determine why these viruses are able to produce such a strong immune response, and why rhinovirus C infections decrease with age. This information may help researchers design a practical vaccine against rhinovirus C that could be used to protect high-risk children.

Where can I learn more?

View the full journal article, titled "Enhanced Neutralizing Antibody Responses to Rhinovirus C and Age-Dependent Patterns of Infection," in American Journal of Respiratory and Critical Care Medicine.

Additional details

The authors thank the many investigators, children and families who conducted and participated in this multinational collaborative study.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published: April 1, 2021

Download this summary

ECHO Study Finds Children Are Less Likely to Get the Common Cold as They Get Older

ECHO Discovery

Co-author James Gern presented An Integrated Approach to Identifying Early Life Causes of Childhood Asthma at a past ECHO Discovery webinar. You can view his presentation here.

Does Age Affect Susceptibility to Getting the Common Cold?

Posted on January 15, 2021April 9, 2025 by Jodi Snare

Rhinovirus is a leading cause of the common cold and wheezing illnesses in young children and individuals with asthma. There are three species of rhinoviruses (A, B, and C), and the C viruses are often more likely to cause wheezing illnesses, especially in young children. Unfortunately, there are no treatments for these respiratory viruses.

To learn more about how age and other personal factors influence susceptibility to getting rhinovirus illnesses, ECHO researchers Timothy Choi, MS; James Gern, MD; and Yury Bochkov, PhD, of the University of Wisconsin School of Medicine and Public Health conducted a multi-year study with more than 4,000 children. This research, titled “Enhanced Neutralizing Antibody Responses to Rhinovirus C and Age-Dependent Patterns of Infection,” is now featured in the American Journal of Respiratory and Critical Care Medicine.

Children ages zero to 19 with illnesses of varying severity participated in 14 independent studies in the United States, Finland, and Australia. Between 2000 and 2019, each site collected and analyzed nasal samples for rhinovirus species and type. The investigators then tested whether characteristics such as age influenced which viruses were found.

“Our research shows that as children age, they are less likely to be infected with rhinovirus C,” said Choi. “This could be because the immune system has a stronger protective response to infection with rhinovirus C species compared to other species.” Other personal factors related to more frequent infections include wheezing respiratory illnesses and a genetic difference in a protein used by the viruses to enter cells.

The results of this study could help identify children at high risk for developing more severe illnesses with rhinovirus C based on young age and genetics. In addition, analyses of more than 10,000 mucus specimens identified viruses that were consistently more common and those more likely to be associated with illness.

“In the future, we want to focus on studying the magnitude and duration of immunity to rhinovirus C to determine why these viruses are able to produce such a strong immune response, and why rhinovirus C infections naturally decline with age,” said Dr. Gern. “This information may help researchers design a practical vaccine against rhinovirus C that could be used to protect high-risk children.”

ECHO Study Suggests Specific Form of Vitamin E Prevents, Treats Bronchopulmonary Dysplasia

<< Back to Research Summaries

ECHO Study Suggests Specific Form of Vitamin E Prevents, Treats Bronchopulmonary Dysplasia

Author(s): Cosby Stone, Cynthia McEvoy, Judy Aschner, et al

Who sponsored this research?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

What were the study results?

The researchers learned:

There was not enough information in existing studies to recommend using vitamin E to prevent BPD.
A specific type of vitamin E called α-tocopherol isoform may be helpful in preventing or treating BPD.

*Results reported here are for a single research review. Other or future reviews or studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

The researchers think that studying the vitamin E α-tocopherol isoform would help provide more information on the benefits and risks of using it to prevent and treat BPD. This type of vitamin E is already associated with better health outcomes for conditions such as asthma, allergic airway swelling, and improved lung growth than other forms of vitamin E. However, without further studies, there is not enough information to recommend it now.

Why was this study needed?

Bronchopulmonary dysplasia (BPD) is a chronic lung disease that mostly affects newborns and infants. It occurs when a newborn or infants’ lungs are damaged from being on a ventilator (a machine that provides oxygen). We already know that there is a connection between low levels of vitamin E and the risk of BPD. Some doctors use vitamin E to help prevent BPD in newborns and infants. However, the last time researchers studied how vitamin E may affect BPD was 1991. Since then, we have learned more about how to reduce the risk of oxygen and ventilator-related lung injuries in newborns. We also know more about how vitamin E affects overall lung health. People only get vitamin E through their diet or supplements, like vitamins, so it’s important to understand if people need more of it.

What was the purpose of the study?

To update our knowledge and understanding of vitamin E and BPD.

Who was involved?

No study participants were involved in this research. The researchers involved are experts in neonatology (the study of newborns), epidemiology (understanding health in certain populations of people), pulmonary medicine (medicine related to the lungs) and environmental interventions (how changing something in a person’s environment affects health.

What happened during the study?

Researchers gathered and analyzed existing research on vitamin E. From this analysis, they suggest ideas for future research that could help us learn more about vitamin E and its role in preventing or treating BPD.

What happens next?

Researchers are interested in studying individual types of vitamin E as dietary supplements to improve lung health and as a potential way to treat or prevent BPD. We will need more and better data from research studies to understand if taking certain vitamin E isoforms can help reduce the risk of:

BPD for newborns when taken by a pregnant women at risk of preterm birth.
BPD for premature newborn when given to the newborn right after birth.
Having long-term lung problems that may continue later into life.

Where can I learn more?

Access the full journal article titled, “Update on Vitamin E and Its Potential Role in Preventing or Treating Bronchopulmonary Dysplasia.”

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

ePublished: March 7, 2018

Download this summary

ECHO Study Suggests Specific Form of Vitamin E Prevents, Treats Bronchopulmonary Dysplasia