Anti-inflammatory Therapy Reduces Wheezing After Bronchiolitis

Reijonen, Tiina M.; Korppi, Matti; Kuikka, Liisa; Remes, Kyllikki

doi:10.1001/archpedi.1996.02170300066013

Cited by 94 publications

(84 citation statements)

References 23 publications

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“…Instead, persistent asthma correlated significantly with the recent presence of other atopic diseases in the subjects. Similar results have been presented by KORPPI and coworkers [87,89]. The findings of these studies fit better with the view that asthma developed in predisposed children rather than with the hypothesis that RSV infection induced a process leading to persistent asthma.…”

Section: Does Wheezing Occur Exclusively Subsequent To Respiratory Sysupporting

confidence: 89%

Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases

Wennergren¹,

Kristjánsson²

2001

Eur Respir J

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Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases. G. Wennergren, S. Kristjánsson. #ERS Journals Ltd 2001. ABSTRACT: Evidence from a large number of prospective case-control studies shows that respiratory syncytial virus (RSV) bronchiolitis in infancy is often associated with recurrent wheezing and asthma during subsequent years. However, wheezing tends to diminish and most studies show no significant increase in wheezing compared to controls by school age or adolescence. An unresolved question is whether severe RSV infection during infancy causes the respiratory sequelae or inherent abnormalities predispose an infant to develop severe respiratory infection and sequelae, i.e. RSV is associated with the development of pulmonary sequelae.Studies on long-term outcome of RSV bronchiolitis are reviewed from an evidencebased perspective.The majority of prospective placebo-controlled studies do not show any long-term beneficial effects of corticosteroid treatment, i.e. the risk of subsequent wheezing is not diminished by the treatment. The evidence for an increased risk of allergic sensitization after RSV bronchiolitis is not nearly as strong as the evidence for an increased risk of subsequent wheezing. In fact, most studies do not show any significant increase in atopy after RSV bronchiolitis. This suggests that the increased risk of wheezing after RSV is not linked to an increased risk of atopy. There are some indications that infants who develop severe RSV and subsequent wheezing may have aberrations that predate the RSV infection.To decide whether respiratory syncytial virus bronchiolitis causes, or is associated with the respiratory sequelae (or with subsequent allergy), it will be necessary to conduct prospective, randomized studies, where the cytokine profile prior to bronchiolitis onset is known. Such studies should preferably include some form of intervention against respiratory syncytial virus. A more complete understanding of the risk factors for severe respiratory syncytial virus infection and the role of respiratory syncytial virus infection in the initiation of asthma is needed as a basis for large-scale and cost-effective programmes to prevent respiratory syncytial virus-related morbidity. Eur Respir J 2001; 18: 1044-1058. Respiratory syncytial virus (RSV) bronchiolitis is the most common, severe lower respiratory tract infection in infancy. It now seems well established that RSV bronchiolitis in infancy is associated with recurrent wheezing and asthma during the first decade of life. In some children, wheezing after early lower airway infection with RSV is transient, but in many of the children RSV-induced bronchiolitis represents the onset of asthma. In fact, there are results which indicate that severe RSV bronchiolitis in the young infant may shift the T-helper (Th)1/Th2 balance in favour of a Th2 cytokine pattern, leading to development of allergic sensitization and persistent asthma [1,2]. However, the association with risk of development of atopy...

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Section: Does Wheezing Occur Exclusively Subsequent To Respiratory Sysupporting

confidence: 89%

Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases

Wennergren¹,

Kristjánsson²

2001

Eur Respir J

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“…This is further supported by a recent randomised controlled trial in 7,241 patients, of whom 1,974 were children aged 5-10 yrs; reporting that long-term inhaled budesonide improved lung function and asthma control in patients with mild persistent asthma, as compared to placebo, when treatment was started v2 yrs after the diagnosis of asthma [4]. However, except from clinical trials of ICS in infants and young children with rBO after hospital admissions for acute bronchiolitis [7,8,21,22] and in infants and young children with severe asthma [9,10], little is known about the extent of use and the effect of ICS upon lung function in very young children. The present 2.1% reported use of ICS among all children in the birth cohort, and in one-fifth of children with rBO, is thought to be the first prevalence report of ICS use in a prospective follow-up cohort study in very young children.…”

Section: Discussionmentioning

confidence: 98%

“…It was further suggested that ICS were usually more effective in children w5 yrs than in younger children, although this was not substantiated by statistical significance [29]. Several studies have demonstrated beneficial effects of ICS in infants and very young children with rBO after admission to hospital due to acute bronchiolitis [7,8,22]; whereas others have not [21].…”

Section: Discussionmentioning

confidence: 99%

Effect of inhaled steroids on lung function in young children: a cohort study

Devulapalli¹,

Haaland²,

Pettersen³

et al. 2004

Eur Respir J

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The objectives of the present study were to determine the use of inhaled corticosteroids (ICS) for treating recurrent bronchial obstruction (rBO) in young children up to 2 yrs of age and to assess possible modifying effects of ICS on lung function in young children with rBO. From an observational, noninterventional birth cohort of 3,754 newborn children (3,697 with complete questionnaire data by 2 yrs of age), 306 children with documented rBO by age 2 yrs (cases) were identified along with 306 matched controls.Two tidal flow/volume measurements were taken, one at presentation of disease (children were steroid naïve) and one at 2 yrs of age (mean age 11.2 and 25.6 months, respectively), from: 21 cases who subsequently received ICS (ICSz); 33 who did not (ICS-); and in 15 controls. The mean¡SD duration of ICS treatment was 10.3¡6.5 months. The main outcomes were treatment with ICS and baseline ratio of time to peak expiratory flow/total expiratory time (tPTEF/tE).From the entire cohort, 77 children (2.1%) and 21% of children with rBO had received ICS by 2 yrs of age. Baseline tPTEF/tE was significantly lower at the first visit only in ICSz as compared to ICS-subjects, as well as in ICSz and ICS-as compared to controls. The mean difference in baseline tPTEF/tE from first to second visit was borderline statistically significant in the ICSz group only and correlated significantly with duration of ICS treatment.The present observational cohort study demonstrated that one-fifth of young children with recurrent bronchial obstruction had received inhaled corticosteroids. Early inhaled corticosteroid treatment improved lung function by age 2 yrs, mostly in those with the longest duration of treatment.

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“…The baseline data were charted by using a structured questionnaire at enrollment, including the history of earlier episodes of wheezing, the history of atopic dermatitis, pet contacts in infancy, and the family history of asthma and atopy. 6 More details are presented in Table 1. In addition, total serum IgE and ECP concentrations and blood eosinophil counts were determined.…”

mentioning

confidence: 99%

Allergen-Specific Immunoglobulin E Antibodies in Wheezing Infants: The Risk for Asthma in Later Childhood

Kotaniemi‐Syrjänen¹,

Reijonen²,

Romppanen³

et al. 2003

PEDIATRICS

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ABSTRACT. Objective. To evaluate whether the measurement of specific immunoglobulin E (IgE) antibodies to food and/or inhalant allergens in infants who are hospitalized for wheezing can be used to predict later asthma.Methods. Eighty-two children who were hospitalized for wheezing at <2 years of age were followed prospectively until early school age. The baseline data and the characteristics of infancy had been collected at enrollment. At school age, the children were evaluated for asthma and allergic manifestations, including skin prick tests to common inhalant allergens. Frozen serum samples obtained during the index episode of wheezing were available for 80 children for determination of food and inhalant allergen-specific serum IgE antibodies by fluoroenzyme-immunometric assay, UniCAP, applying the Phadiatop Combi allergen panel.Results. Asthma was present in 32 (40%) children at school age. Food-specific IgE antibodies of >0.35 kU/L were found in 37 (46%) wheezing infants, but only specific IgE to wheat and to egg white at the level of >0.35 kU/L were significantly associated with later asthma. In regard to specific IgE to the mixture of food allergens, the cutoff level of >0.70 proved to be significant. Inhalant allergen-specific IgE of >0.35 kU/L was found only in 14 cases (18%), but when present, it was significantly predictive of asthma. Elevated levels of specific IgE antibodies to food or inhalant allergens were significantly associated with allergic rhinitis and skin-test reactivity at school age.Conclusions. When present in wheezing infants, specific IgE of >0.35 kU/L to wheat, egg white, or inhalant allergens are predictive of later childhood asthma. Consequently, detection of those specific IgE antibodies in wheezing infants may facilitate the early diagnosis of asthma, especially in cases with no clinically evident atopic manifestations. A pproximately 20% of all children experience wheezing in infancy, 1 and these children are at increased risk for asthma in later childhood. On the basis of recent prospective follow-up data, up to 40% of them experience asthma at school age. 2 The majority of children with asthma have clinically evident atopic manifestations in later childhood, although allergies may not be apparent in infancy. 2,3 Total serum immunoglobulin E (IgE), 2 blood eosinophilia, 2 and serum eosinophil cationic protein (ECP) 4 are markers that are often used to determine subclinical atopy and susceptibility to respiratory allergy. However, these markers are nonspecific, and to point out the allergen-specific responses, skin prick tests (SPTs) or radioallergosorbent tests (RAST) thus far have had to be performed. Both of these tests are qualitative, and for technical reasons, only a restricted number of allergens are applicable in SPTs in young children. These tests may also be susceptible to technical errors and variations as a result of either nonstandardized or nonautomated methods. Consequently, new approaches are needed to screen those prone to atopy or allergen-induced asthma among ...

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Anti-inflammatory Therapy Reduces Wheezing After Bronchiolitis

Cited by 94 publications

References 23 publications

Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases

Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases

Effect of inhaled steroids on lung function in young children: a cohort study

Allergen-Specific Immunoglobulin E Antibodies in Wheezing Infants: The Risk for Asthma in Later Childhood

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