Risk of childhood wheeze and asthma after respiratory syncytial virus infection in full‐term infants

Abstract

BackgroundMost studies addressing the association between RSV and recurrent wheezing (RW) and asthma have been conducted in patients at risk for lung morbidity. Data in full‐term infants are limited.MethodsThe risk of RW/asthma during the first 5 years of life in full‐term infants hospitalized with RSV during the first year (Y) of life was estimated using 2010‐16 data from three claims databases in USA (Truven MarketScan Commercial Claims and Encounters Database [CCAE], Truven Health MarketScan Multi‐State Medicaid [MDCD], and Optum Clinformatics Extended Data Mart‐Socio‐Economic Status [SES]). Full‐term infants with and without RSV infection and ≥ 2 years of continuous health plan enrollment from birth were included. Incidence rates of RW/asthma, cumulative incidence, adjusted incidence rate ratios (aIRR), and odds ratios (aOR) were calculated.ResultsDuring the 16‐year study, 38,494 (CCAE), 62 846 (MDCD), and 23 099 (SES) matched infant pairs were included in each cohort. In the CCAE database, RW/asthma incidence/1000 patient‐years (69.7 vs 28.7, aIRR: 2.4 [2.3‐2.5]); cumulative incidence (17.6%‐25.2% vs 5.0%‐11.4%); and aOR (Y2: 4.1 [3.9‐4.4]; Y3: 3.2 [3.0‐3.3]; Y4: 2.9 [2.7‐3.1]; Y5: 2.6 [2.5‐2.9]) were higher in the RSV vs. non‐RSV cohort. Results in the SES insured population were comparable, while cumulative incidence and aIRR were higher in the Medicaid population (MDCD).ConclusionAlthough there are limitations in this study, including possible coding errors and missing covariates, we showed that full‐term infants with severe RSV infection during the first year of life, spanning several respiratory seasons and a geographically diverse population, are at significant risk of RW/asthma during childhood.

Assessment of the Effects of Active Immunisation against Respiratory Syncytial Virus (RSV) using Decision-Analytic Models: A Systematic Review with a Focus on Vaccination Strategies, Modelling Methods and Input Data

“…Premature infants and children with severe respiratory disease, congenital heart disease, cancer, cystic fibrosis, immune deficiency, or Down syndrome have been reported to be at increased risk for severe RSV infection [6,7]. Moreover, severe RSV disease during infancy presents a considerable risk for the development of recurrent wheezing and asthma later in life [8,9]. Asymptomatic or mild RSV reinfections are common in adult life [10], with more severe manifestation in immunocompromised individuals [11], patients with cardiopulmonary diseases, and the elderly [12].…”

Decoding Susceptibility to Respiratory Viral Infections and Asthma Inception in Children

“…There are more than 5.5 million asthmatic children in the US, and asthma exacerbations account for more than 550,000 ED visits, 100,000 hospitalisations and 4 million GP visits [11]. In addition to the burden of HRSV-and HRV-induced acute illness on health care resources, severe illnesses with either of these viruses are strongly linked to the development of persistent wheeze and asthma [5,12,13]. What remains an open question is whether or not these viral agents drive the development of the various clinical manifestations of asthma and wheeze (e.g., atopic asthma, non-atopic asthma, and transient/persistent/recurrent wheezing) in susceptible individuals or alternatively unmask a pre-existing susceptibility in children who were already on a trajectory towards asthma.…”

Asthma from infancy to childhood, and allergy perception in adolescents

“…Atopic dermatitis and male sex could also be associated with recurrent wheezing. It is well known that early respiratory viral infections are major risk factors for later asthma, and in this study, palivizumab given for prophylaxis of RSV during the first year of life decreased the risk or recurrent wheezing in the third year of life. Studies on early‐life wheezing and later trajectories for obstructive respiratory diseases are limited by the variety of the clinical phenotypes and the complexity of the pathomechanisms.…”