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Bronchiolitis in the history of the asthmatic child
M P Villa1, G De Castro, E Porro
1Department of Paediatrics, University of Rome, Italy.
Insights
Children with a history of bronchiolitis often develop asthma earlier and experience fewer atopic symptoms. This suggests distinct mechanisms for asthma following bronchiolitis compared to typical atopic asthma.
Area of Science:
- Pediatrics
- Pulmonology
- Epidemiology
Background:
- Bronchiolitis is a common viral respiratory infection in infants.
- Asthma is a chronic respiratory disease characterized by bronchial hyperreactivity.
- The relationship between early-life bronchiolitis and subsequent asthma development requires further investigation.
Purpose of the Study:
- To investigate the clinical characteristics of asthma in children with a history of bronchiolitis.
- To compare asthmatic children with and without a history of bronchiolitis.
- To explore potential differences in the underlying mechanisms of asthma.
Main Methods:
- Retrospective analysis of 1,700 asthmatic children's medical histories.
- Matching 167 cases of asthma with prior bronchiolitis against 215 asthma cases without bronchiolitis.
- Data extraction from clinical records at an Ambulatory Care Unit for Asthma.
Main Results:
- Asthma onset was significantly earlier in children with a history of bronchiolitis (p < 0.001).
- Symptom resolution was earlier in asthmatic children with prior bronchiolitis (p < 0.05 total; p < 0.01 females).
- Less evidence of atopy was observed in asthmatic children with a history of bronchiolitis (p < 0.005).
Conclusions:
- Asthma following bronchiolitis may involve different pathophysiological mechanisms than typical atopic asthma.
- The viral infection in bronchiolitis could induce processes leading to bronchial hyperreactivity.
- Further long-term studies are needed to elucidate the link between bronchiolitis and asthma development.
Abstract:
In a retrospective analysis of the history of 1,700 asthmatic children, 167 (9.8%) were found to have had bronchiolitis during the first 2 years of life. These 167 cases with asthma and bronchiolitis were matched against 215 selected cases of asthma without bronchiolitis. Both groups attended our Ambulatory Care Unit for Asthma. Data were collected from the clinical cards of the children. Asthmatics who had bronchiolitis were found to have an earlier onset of asthma (p less than 0.001), earlier resolution of symptoms (p less than 0.05 total; p less than 0.01 females), and less evidence of atopy (p less than 0.005). It is suggested therefore that the bronchial hyperreactivity in asthma following bronchiolitis may have different underlying mechanisms than in the typical atopic case, without preceding bronchiolitis. Long-term follow-up studies in infants with bronchiolitis are still necessary in order to clarify the process by which bronchiolitis predisposes to bronchial hyperreactivity and asthma. The consequences of the viral infection itself may lead to pathophysiological processes that promote bronchial hyperreactivity. On the contrary, an underlying condition of bronchial hyperreactivity could be the "primum movens" of the bronchiolitis itself.