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Asthma and lung function 20 years after wheezing in infancy: results from a prospective follow-up study
Eija Piippo-Savolainen1, Sami Remes, Senja Kannisto
1Department of Pediatrics, Kuopio University Hospital, and Kuopio University, Kuopio, Finland.
Insights
Infant bronchiolitis significantly increases the risk of developing asthma into adulthood. This long-term study confirms a persistent asthma risk following early-life wheezing, highlighting the importance of monitoring respiratory health.
Area of Science:
- Pediatric Pulmonology
- Epidemiology
- Allergy and Immunology
Background:
- Wheezing and pneumonia in infancy are common respiratory issues with potential long-term health implications.
- Understanding the adult outcomes of these early-life conditions is crucial for effective management and prevention strategies.
Purpose of the Study:
- To investigate the long-term respiratory health outcomes until adulthood in individuals who experienced wheezing (bronchiolitis) or pneumonia in infancy.
- To compare these outcomes with a control group without early-life respiratory hospitalizations.
Main Methods:
- A prospective, 18- to 20-year cohort study involving children hospitalized for bronchiolitis or pneumonia in infancy, and a control group.
- Assessments included questionnaires, physical examinations, spirometry (flow volume spirometry), methacholine challenge tests, and allergy testing (skin prick tests).
Main Results:
- Infantile bronchiolitis was identified as an independent risk factor for adult asthma, even after adjusting for atopy and smoking.
- Asthma prevalence was higher in the bronchiolitis group (30-41%) and pneumonia group (15-24%) compared to controls (11%).
- Bronchial reactivity was also more prevalent in the bronchiolitis and pneumonia groups compared to controls.
Conclusions:
- The increased risk for developing asthma persists from infancy through adulthood following bronchiolitis.
- Early-life respiratory infections like bronchiolitis have significant and lasting impacts on respiratory health into adulthood.
Objective:
To determine the outcome until adulthood after wheezing in infancy, compared with pneumonia in infancy and with controls.
Design:
An 18- to-20-year prospective cohort study.
Setting:
Pediatric department at a university hospital, providing primary hospital care for a defined population. Patients Fifty-four children hospitalized for bronchiolitis and 34 for pneumonia at younger than 2 years, and 45 controls with no early-life wheezing or hospitalization, were studied at median age 19 years.
Main Outcome Measures:
A questionnaire on asthma symptoms and medication, physical examination, flow volume spirometry (FVS), methacholine inhalation challenge (MIC), home peak expiratory flow (PEF) monitoring, and skin prick testing (SPT) to common inhalant allergens. The 2 asthma definitions were physician-diagnosed asthma and previously diagnosed asthma with recent asthmatic symptoms (physician-diagnosed asthma included).
Results:
By the 2 definitions, asthma was present in 30% (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.12-10.10) and in 41% (OR 1.38; 95% CI, 0.37-5.21) in the bronchiolitis group, in 15% (OR, 5.50; 95% CI, 1.87-16.14) and in 24% (OR, 2.07; 95% CI, 0.59-7.22) in the pneumonia group, and in 11% in the control group. After bronchiolitis, the FVS values were forced vital capacity (FVC), 108% (SD, 13%) of predicted; forced expiratory volume in 1 second, 98% (SD, 12%); forced expiratory volume in 1 second divided by FVC, 91% (SD, 7.6%); midexpiratory flow at 50% of the FVC, 74% (SD, 19%); and midexpiratory flow at 25% of the FVC, 74% (SD, 22%). Bronchial reactivity by MIC was present in 25 (48%) of 52 subjects in the bronchiolitis group, in 13 (42%) of 31 in the pneumonia group, and in 14 (32%) of 44 in the control group. The prevalence of atopy (positive SPTs) was 48% to 63% in the 3 groups. In a logistic regression adjusted for atopy and smoking, infantile bronchiolitis was an independent risk factor for asthma by both definitions.
Conclusion:
The increased risk for asthma persists until adulthood after bronchiolitis in infancy.
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