Risk factors for recurrent wheezing following acute bronchiolitis: A 12‐month follow‐Up

Abstract

The objective of this study was to identify wheezing recurrences and related risk factors in two groups of infants with bronchiolitis: respiratory syncytial virus (RSV)+ and RSV- as determined by RSV enzyme immunoassay. A 1-year prospective cohort study was conducted with infants younger than 2 years old. Follow-up was made monthly, by a clinical visit and/or by telephone, checking the number of wheezing episodes per month and possible related risk factors. There were 96 subjects enrolled, of whom 77 reached complete follow-up: 36 were RSV+ (46.8%), and 41 were RSV- (53.2%). In the RSV+ group, there were 17 males (47%), vs. RSV- with 30 males (73%) (P < 0.05); 22 RSV+ (61%) were admitted to hospital, vs.14 RSV- (34%) (P < 0.05). Mean age was not significantly different in both groups. The mean number of recurrences was 3.36 episodes/infant/year in the RSV+ and 2.34 in the RSV- group (P = 0.06). Crude relative risk (RR) for a new recurrence of an obstructive episode was 1.33 (95% CI, 0.99-1.79). After adjustment for several potential confounders, the RR was 1.41 (95% CI, 1.03-1.93). Hospitalization stay was longer in the RSV+ than the RSV- group (P < 0.05). In the RSV+ group, patients who had been hospitalized showed more recurrences (4.18) than those with outpatient treatment (2.07) (P < 0.05); this difference did not exist in the RSV- group. The related risk factors for recurrent wheeze in the RSV- group were male gender, number of siblings, and daycare attendance (P < 0.05). In the RSV+ group, the risk of recurrent wheeze was only increased by admission to hospital during the acute bronchiolitis episode (P < 0.05). We speculate that there may be a higher rate of increased airway reactivity and/or preexisting diminished lung function in RSV+ infants requiring hospitalization for their initial illness. In conclusion, RSV-proven bronchiolitis, particularly in those infants who are hospitalized, is associated with a higher recurrence of wheezing episodes in the subsequent 12 months. Other factors appear to account for recurrent wheeze in the RSV- group.

Viral etiology of hospitalized acute lower respiratory infections in children under 5 years of age – a systematic review and meta-analysis

“…Figure 2 presents geographical distribution of the retained studies, Figure 3 shows proportion of studies investigating different viruses (any virus, RSV, IV, PIV, AV, CV), while Table 1 presents their basic characteristics in terms of case definition, sample size, period of study, and diagnostic methods used (15,40,46-94). Only four studies investigated children hospitalized with ALRI for both bacterial and viral etiology (59,64,69,74) and only six studies reported HIV co-infection as their exclusion criteria (15,58,59,63,64,86). A total of 19 studies were from high-income countries (95), investigating on average 6.5 viruses per study, while studies in LMIC investigated 2.7 viruses (unpaired t test: P  = 0.002).…”

“…Bronchiolitis is characterized by a distressing pattern of symptoms: low-grade/absent fever progressing to cough, coryza, tachypnoea, hyperinflation, chest retraction, and widespread crackles or wheezes (12). Bronchiolitis deaths are very rare in HIC (13,14), but children are at increased risk of recurrent wheezing and the data on mortality in low and middle income countries (LMIC) are scarce (15). …”

Predictors of Inappropriate Use of Diagnostic Tests and Management of Bronchiolitis

“…We found that a greater number of siblings was associated with an increased risk of inappropriate diagnosis and management of bronchiolitis; however the reason for this association is not entirely clear. A reasonable explanation for this association may be due to the fact that the number of siblings has been reported as an independent predictor for recurrent wheezing following acute bronchiolitis [13]. It is probable that some of these recurrent wheezing episodes have been diagnosed as acute viral bronchiolitis but have been treated as acute asthma exacerbations.…”

Chronic recurrent multifocal osteomyelitis is a differential of childhood limp

“…We chose potential explanatory variables which had been previously identified as factors which might influence RSV infection and/or respiratory morbidity in prematurely born infants. [15][16][17][18] Antenatal variables recorded were antenatal infection (maternal positive blood culture, histologically proven chorioamnionitis, maternal urinary tract infection, or maternal temperature with a positive culture from a high vaginal swab and rupture of membranes of duration greater than 24 hours 13 ), maternal smoking, and antenatal corticosteroid administration. Postnatal variables were sex, gestational age, birth weight, use of surfactant, postnatal infection, the number of days of mechanical ventilation, BPD, discharge from the neonatal unit between September and December, and whether the infant was bottle fed.…”