19 Children Hospitalized With Rhinovirus Bronchiolitis Have Asthma-Like Characteristics

Abstract

Children with bronchiolitis often are considered a homogeneous group. However, in a multicenter, prospective study of 2,207 young children hospitalized for bronchiolitis, we found that children with respiratory syncytial virus detected differ from those with rhinovirus detected; the latter patients resemble older children with asthma, including more frequent treatment with corticosteroids. Keywords respiratory syncytial virusBronchiolitis, the leading cause of hospitalization for US infants, is caused by a diverse group of viruses [1]. Respiratory syncytial virus (RSV) is the most common virus associated with severe bronchiolitis (ie, bronchiolitis requiring hospitalization), and rhinovirus is the second most common [2]. The 2014 American Academy of Pediatrics bronchiolitis clinical practice guideline recommends that clinicians not test children with bronchiolitis for viruses because identifying the viral etiology will not change the child's management [3]. In other Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Emerging evidence suggests that bronchiolitis actually is a heterogeneous condition with different short-term and long-term outcomes. Based on small studies (n<280), children with rhinovirus-associated bronchiolitis have different demographics, are more likely to have a prior history of wheezing, and more often are treated with corticosteroids in the acute setting compared with young children infected with other viruses [4,5]. Moreover, children hospitalized with rhinovirus-associated bronchiolitis have been shown, in two separate populations, to have a shorter length of stay than children with RSV bronchiolitis [2,6]. In addition to these short-term differences, early childhood rhinovirus-associated wheezing illnesses, such as bronchiolitis, are associated with an increased risk of school-age asthma compared with RSV-induced wheezing illnesses [7]. Taken together these findings suggest that bronchiolitis is not a homogeneous condition. HHS Public AccessWe recently completed a prospective, multicenter, multiyear study of over 2,000 children hospitalized with bronchiolitis [2]. In this secondary analysis, we hypothesized that children hospitalized with rhinovirus-associated bronchiolitis would be more likely than their counterparts with RSV infection to have asthma-like characteristics (ie, prior wheezing, atopic characteristics, and more frequent treatment with corticosteroids). MethodsThis is a secondary analysis of the 30 th Multicenter Airway Research Collaboration (MARC-30) prospective observational study of children hospitalized with bronchiolitis. T...