Clinical and Virus Surveillance After the First Wheezing Episode

Abstract

Background Susceptibility to rhinovirus (RV) induced early wheezing episode has been recognized as an important risk factor for asthma but the data on different RV species is limited. Our aim was to investigate the risk for recurrences in first-time wheezing children with special focus on RV species. Methods First-time wheezing children (88/23 in-/outpatients) were prospectively followed at 2-week, 2-month and 12-month time-points, and at first recurrence within 12 months. The respiratory virus etiology was analyzed using PCR. RV positive samples were sequenced. The primary outcomes were time to a new physician-confirmed wheezing episode and time to the initiation of regular controller medication for asthma symptoms. Results The median age of the children was 12 months (SD 6.0), 67% were males and 23% were sensitized. RV dominated in symptomatic and asymptomatic infections. Different virus strains caused 97 % of the consecutive RV infections. First-time wheezing children with RV-C (respectively 3.6; p < 0.001) and RV-A (hazard ratio 3.6, p = 0.002) had an increased risk for a new wheezing episode than non-RV group. Also, the risk for the initiation of regular controller medication was increased in RV-A and RV-C groups (both p < 0.05), respectively. There was no difference in response on oral prednisolone between RV-A and RV-C. Conclusions RV causes reinfections with different strains in small children after the first wheezing episode. Both RV-A and RV-C affected children have an increased risk for recurrence and initiation of regular controller medication than those with other viruses.

Rhinovirus and preschool wheeze

“…on children with acute wheeze, where RV‐C was the dominating RV species (67.5%), and associated with increased risk of recurrent wheezing episodes with hospital admissions not found with any other RV species or any other virus in their cohort . Detection of RV‐A and/or RV‐C in children with their first wheezing episode has also been associated with increased risk for recurrence and initiation of ICS medication, not seen in children infected with other viruses …”

“…56 Detection of RV-A and/or RV-C in children with their first wheezing episode has also been associated with increased risk for recurrence and initiation of ICS medication, not seen in children infected with other viruses. 57 There are, however, several recent studies where no association between RV type and severity of respiratory infection has been found, 58 and therefore, clinical significance of RV-C is still debated.…”

Role of viral infections in the development and exacerbation of asthma in children

“…There are several differences between RV-and RSV-induced illnesses with respect to at-risk populations and clinical characteristics. 36,62 Children hospitalized for RV-induced wheezing tend to be older, are more likely to have wheezed previously, more often have allergic sensitization compared with those with RSV-induced wheezing, 5,7,33,[63][64][65][66] and also show a favorable response to oral corticosteroid treatment whereas those with RSV-induced wheezing do not. 67,68 Although RSV can generally cause more severe infections in infants than RV, the inception of wheeze might be more rapid (and duration shorter) with RV compared with RSV infection.…”

Differential diagnostics and treatment tactics of pediatrician at repeated episodes of broncho-obstructive syndrome

“…Читайте нас на сайте: http://med expert.com.ua ніше. Результати європейських досліджень теж звертають увагу на те, що приблизно у 50% дітей першого року життя був, принаймні, один епізод БОС [2,8]; при цьому він зустрічається переважно у перші 5-6 років життя. Однак при виникненні вже першого епізоду БОС слід встановити його причину, що визначить склад і обсяг терапії.…”