Determinants of asthma after severe respiratory syncytial virus bronchiolitis

Abstract

Background The development of asthma after respiratory syncytial virus (RSV) bronchiolitis has been demonstrated in case-control studies, although the determinants of post-RSV asthma remain undefined. Objectives We sought to evaluate the potential determinants of physician-diagnosed asthma after severe RSV bronchiolitis during infancy. Methods We enrolled 206 children during an initial episode of severe RSV bronchiolitis at 12 months of age or less in a prospective cohort study and followed these children for up to 6 years. In a subset of 81 children, we analyzed CCL5 (RANTES) mRNA expression in upper airway epithelial cells. Results Forty-eight percent of children had physician-diagnosed asthma before the seventh birthday. Independent determinants significantly associated with increased risk for physician-diagnosed asthma by the seventh birthday included maternal asthma (odds ratio [OR], 5.2; 95% CI, 1.7-15.9; P = .004), exposure to high levels of dog allergen (OR, 3.2; 95% CI, 1.3-7.7; P = .012), aeroallergen sensitivity at age 3 years (OR, 10.7; 95% CI, 2.1-55.0; P = .005), recurrent wheezing during the first 3 years of life (OR, 7.3; 95% CI, 1.2-43.3; P = .028), and CCL5 expression in nasal epithelia during acute RSV infection (OR, 3.8; 95% CI, 1.2-2.4; P < .001). White children (OR, 0.19; 95% CI, 0.04-0.93; P = .041) and children attending day care (OR, 0.18; 95% CI, 0.04-0.84; P = .029) had a decreased risk of physician-diagnosed asthma. Conclusions Approximately 50% of children who experience severe RSV bronchiolitis have a subsequent asthma diagnosis. The presence of increased CCL5 levels in nasal epithelia at the time of bronchiolitis or the development of allergic sensitization by age 3 years are associated with increased likelihood of subsequent asthma.

19 Children Hospitalized With Rhinovirus Bronchiolitis Have Asthma-Like Characteristics

“…These repeat treatment trials also may prove important for long-term outcomes because 40-50% of infants with severe bronchiolitis will be recognized to have childhood asthma [1,9] and children with rhinovirus-associated bronchiolitis may be at particularly high risk [1]. Unfortunately, because there is no instrument yet that can reliably predict which children with bronchiolitis have or will develop asthma, there also is no means of accurately conducting prevention trials.…”

“…Although RSV is the most common viral etiology of severe bronchiolitis and the results of these well conducted studies remain valid, the present data in combination with other reports [2,[6][7][8] suggest that these large-scale studies probably should be repeated in children with rhinovirus-associated bronchiolitis. A change in practice for this sub-group would affect the short-term outcomes of an estimated 25,000 US children age <2 years hospitalized annually with rhinovirus-associated bronchiolitis and many more world-wide [1].These repeat treatment trials also may prove important for long-term outcomes because 40-50% of infants with severe bronchiolitis will be recognized to have childhood asthma [1,9] and children with rhinovirus-associated bronchiolitis may be at particularly high risk [1]. Unfortunately, because there is no instrument yet that can reliably predict which children with bronchiolitis have or will develop asthma, there also is no means of accurately conducting prevention trials.…”

Le microbiome pulmonaire en 2015

“…Il évoluera dans le temps en fonction de la pathologie mais, quelle qu'elle ronnement dans lequel les enfants grandissent (milieu rural versus milieu urbain), sa contamination bactérienne et fongique, et le risque de développer une atopie ou un asthme [38,39]. Par ailleurs, les infections virales, notamment les bronchiolites de l'enfance et en particulier celles à rhinovirus, semblent être impliquées dans la genèse de l'asthme, peut-être sur des terrains prédisposés [40][41][42]. Aujourd'hui, de nombreuses données tendent à montrer que plus le microbiote environnemental est diversifié, moins le risque de développer un asthme est important.…”

A systematic review of predictive modeling for bronchiolitis

“…As one predictive model does not fit all, we should develop separate predictive models for children presenting with bronchiolitis at <6, 6-12, and 13-24 months of age [240]. Since characteristics associated with future asthma diagnosis after bronchiolitis vary by age [225], we should choose a targeted age and build predictive models specifically for it.…”