Journal List > Pediatr Allergy Respir Dis > v.22(1) > 1033210

Kim and Shin: The Relationship between the Time of First Respiratory Syncytial Virus Bronchiolitis and Later Wheezing and Asthma Development

Abstract

Purpose

Respiratory syncytial virus(RSV) bronchiolitis is believed to be associated with later development of asthma and wheezing. This study was conducted to determine the relationship between the age of the first RSV bronchiolitis episode, the development of later wheezing and asthma, and the related other factors.

Methods

We studied 255 infants admitted with their first episode of RSV bronchiolitis. Epidemiological and clinical data were collected retrospectively from medical records and through telephone interviews. The patients were divided into ≤3 months, 4 to 12 months, and 13 to 24 months.

Results

Eighty-one infants were ≤3 months, 115 were 4 to 12 months, and 59 were 13 to 24 months old. The gender ratios (Male:Female) were 1:1, 1.6:1, and 3.2:1. Familial and personal history of allergic diseases and disease severity did not significantly differ according to the age of the first RSV bronchiolitis episode. The occurrence of wheezing was associated with the presence of a familial and personal history of allergic diseases, but not with gender (male) or disease severity. The risk for asthma increased when the infants had their first RSV bronchiolitis episode at an older age. A personal history of allergic diseases was associated with an increased risk for asthma.

Conclusion

Asthma was more frequently diagnosed in older infants. The most important risk factors for recurrent wheezing and asthma were a familial and personal history of allergic diseases. Therefore, it was thought that RSV bronchiolitis is not the cause of recurrent wheezing and asthma, but that infants with a genetic predisposition to asthma have an increased risk for RSV bronchiolitis.

Figures and Tables

Fig. 1
Sex distribution according to the age groups.
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Table 1
Clinical Scoring System Using Initial Symptom Severity
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Table 2
Demographic Features of Study Population
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Values are presented as number (%) or mean±SD.

Table 3
Clinical Data after First RSV Bronchiolitis according to the Age Groups
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Values are presented as number (%) or mean±SD.

AD, atopic dermatitis; FA, food allergy; AR, allergic rhinitis; BA, bronchial asthma; URI, upper respiratory infection.

Table 4
Wheezing within 2 Years and the Correlating Factors
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Values are presented as number (%) or mean±SD.

AD, atopic dermatitis; FA, food allergy; AR, allergic rhinitis; BA, bronchial asthma.

Table 5
Asthma Diagnosis within 2 Years after First RSV Bronchiolitis and the Correlating Factors
pard-22-54-i005

OR, odds ratio; aOR, adjusted odds ratio; CI, confidence interval.

*aOR is adjusted by age, sex, allergic disease history, allergic family history, atopic dermatitis, initial symptom severity, systemic steroid treatment.

References

1. Henderson FW, Clyde WA Jr, Collier AM, Denny FW, Senior RJ, Sheaffer CI, et al. The etiologic and epidemiologic spectrum of bronchiolitis in pediatric practice. J Pediatr. 1979. 95:183–190.
crossref
2. Panitch HB. Bronchiolitis in infants. Curr Opin Pediatr. 2001. 13:256–260.
crossref
3. Wennergren G, Hansson S, Engström I, Jodal U, Amark M, Brolin I, et al. Characteristics and prognosis of hospital-treated obstructive bronchitis in children aged less than two years. Acta Paediatr. 1992. 81:40–45.
crossref
4. Wennergren G, Kristjánsson S. Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases. Eur Respir J. 2001. 18:1044–1058.
crossref
5. Korppi M, Reijonen T, Pöysä L, Juntunen-Backman K. A 2- to 3-year outcome after bronchiolitis. Am J Dis Child. 1993. 147:628–631.
crossref
6. Stein RT, Sherrill D, Morgan WJ, Holberg CJ, Halonen M, Taussig LM, et al. Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years. Lancet. 1999. 354:541–545.
crossref
7. Sigurs N, Bjarnason R, Sigurbergsson F, Kjellman B. Respiratory syncytial virus bronchiolitis in infancy is an important risk factor for asthma and allergy at age 7. Am J Respir Crit Care Med. 2000. 161:1501–1507.
crossref
8. Osundwa VM, Dawod ST, Ehlayel M. Recurrent wheezing in children with respiratory syncytial virus (RSV) bronchiolitis in Qatar. Eur J Pediatr. 1993. 152:1001–1003.
crossref
9. Schauer U, Hoffjan S, Bittscheidt J, Köchling A, Hemmis S, Bongartz S, et al. RSV bronchiolitis and risk of wheeze and allergic sensitisation in the first year of life. Eur Respir J. 2002. 20:1277–1283.
crossref
10. Culley FJ, Pollott J, Openshaw PJ. Age at first viral infection determines the pattern of T cell-mediated disease during reinfection in adulthood. J Exp Med. 2002. 196:1381–1386.
crossref
11. Dakhama A, Park JW, Taube C, Joetham A, Balhorn A, Miyahara N, et al. The enhancement or prevention of airway hyperresponsiveness during reinfection with respiratory syncytial virus is critically dependent on the age at first infection and IL-13 production. J Immunol. 2005. 175:1876–1883.
crossref
12. Miller EK, Lu X, Erdman DD, Poehling KA, Zhu Y, Griffin MR, et al. Rhinovirus-associated hospitalizations in young children. J Infect Dis. 2007. 195:773–781.
crossref
13. Jartti T, Korppi M. Rhinovirus-induced bronchiolitis and asthma development. Pediatr Allergy Immunol. 2011. 22:350–355.
crossref
14. Singh AM, Moore PE, Gern JE, Lemanske RF Jr, Hartert TV. Bronchiolitis to asthma: a review and call for studies of gene-virus interactions in asthma causation. Am J Respir Crit Care Med. 2007. 175:108–119.
15. Ho L, Collis G, Landau LI, Le Souef PN. Effect of salbutamol on oxygen saturation in bronchiolitis. Arch Dis Child. 1991. 66:1061–1064.
crossref
16. Bertrand P, Araníbar H, Castro E, Sánchez I. Efficacy of nebulized epinephrine versus salbutamol in hospitalized infants with bronchiolitis. Pediatr Pulmonol. 2001. 31:284–288.
crossref
17. Stensballe LG, Kristensen K, Simoes EA, Jensen H, Nielsen J, Benn CS, et al. Atopic disposition, wheezing, and subsequent respiratory syncytial virus hospitalization in Danish children younger than 18 months: a nested case-control study. Pediatrics. 2006. 118:e1360–e1368.
crossref
18. Boyce TG, Mellen BG, Mitchel EF Jr, Wright PF, Griffin MR. Rates of hospitalization for respiratory syncytial virus infection among children in medicaid. J Pediatr. 2000. 137:865–870.
crossref
19. Fryzek JP, Martone WJ, Groothuis JR. Trends in chronologic age and infant respiratory syncytial virus hospitalization: an 8-year cohort study. Adv Ther. 2011. 28:195–201.
crossref
20. Welliver RC. Review of epidemiology and clinical risk factors for severe respiratory syncytial virus (RSV) infection. J Pediatr. 2003. 143:5 Suppl. S112–S117.
crossref
21. Thomsen SF, van der Sluis S, Stensballe LG, Posthuma D, Skytthe A, Kyvik KO, et al. Exploring the association between severe respiratory syncytial virus infection and asthma: a registry-based twin study. Am J Respir Crit Care Med. 2009. 179:1091–1097.
crossref
22. Sigurs N, Gustafsson PM, Bjarnason R, Lundberg F, Schmidt S, Sigurbergsson F, et al. Severe respiratory syncytial virus bronchiolitis in infancy and asthma and allergy at age 13. Am J Respir Crit Care Med. 2005. 171:137–141.
crossref
23. Poorisrisak P, Halkjaer LB, Thomsen SF, Stensballe LG, Kyvik KO, Skytthe A, et al. Causal direction between respiratory syncytial virus bronchiolitis and asthma studied in monozygotic twins. Chest. 2010. 138:338–344.
crossref
24. Lehtinen P, Ruohola A, Vanto T, Vuorinen T, Ruuskanen O, Jartti T. Prednisolone reduces recurrent wheezing after a first wheezing episode associated with rhinovirus infection or eczema. J Allergy Clin Immunol. 2007. 119:570–575.
crossref
25. Bülow SM, Nir M, Levin E, Friis B, Thomsen LL, Nielsen JE, et al. Prednisolone treatment of respiratory syncytial virus infection: a randomized controlled trial of 147 infants. Pediatrics. 1999. 104:e77.
26. van Woensel JB, Kimpen JL, Sprikkelman AB, Ouwehand A, van Aalderen WM. Long-term effects of prednisolone in the acute phase of bronchiolitis caused by respiratory syncytial virus. Pediatr Pulmonol. 2000. 30:92–96.
crossref
27. Bradley JP, Bacharier LB, Bonfiglio J, Schechtman KB, Strunk R, Storch G, et al. Severity of respiratory syncytial virus bronchiolitis is affected by cigarette smoke exposure and atopy. Pediatrics. 2005. 115:e7–e14.
crossref
28. Trefny P, Stricker T, Baerlocher C, Sennhauser FH. Family history of atopy and clinical course of RSV infection in ambulatory and hospitalized infants. Pediatr Pulmonol. 2000. 30:302–306.
crossref
29. Kneyber MCJ, Steyerberg EW, de Groot R, Moll HA. Long-term effects of respiratory syncytial virus (RSV) bronchiolitis in infants and young children: a quantitative review. Acta Paediatr. 2000. 89:654–660.
crossref
30. Murray M, Webb MS, O'Callaghan C, Swarbrick AS, Milner AD. Respiratory status and allergy after bronchiolitis. Arch Dis Child. 1992. 67:482–487.
crossref
31. Noble V, Murray M, Webb MS, Alexander J, Swarbrick AS, Milner AD. Respiratory status and allergy nine to 10 years after acute bronchiolitis. Arch Dis Child. 1997. 76:315–319.
crossref
32. Park HJ, Kim SY, Lee KH, Lee GH, Choi EJ, Kim JK, et al. Developmental changes in immune responses during respiratory syncytial virus bronchiolitis. Pediatr Allergy Respir Dis. 2007. 17:101–108. (Korea).
33. Ehlenfield DR, Cameron K, Welliver RC. Eosinophilia at the time of respiratory syncytial virus bronchiolitis predicts childhood reactive airway disease. Pediatrics. 2000. 105(1 Pt 1):79–83.
crossref
34. Piippo-Savolainen E, Remes S, Korppi M. Does blood eosinophilia in wheezing infants predict later asthma? A prospective 18-20-year follow-up. Allergy Asthma Proc. 2007. 28:163–169.
crossref
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