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Respiratory status and allergy after bronchiolitis
M Murray1, M S Webb, C O'Callaghan
1Department of Child Health, University Hospital, Nottingham.
Insights
Infants hospitalized with viral bronchiolitis have significantly increased wheezing and respiratory symptoms years later. Bronchiolitis is a key predictor of persistent wheezing, independent of personal atopy.
Area of Science:
- Pediatric Pulmonology
- Epidemiology of Respiratory Diseases
Background:
- Viral bronchiolitis in infancy is a common respiratory illness.
- Long-term respiratory sequelae following infant bronchiolitis are a significant public health concern.
Purpose of the Study:
- To investigate the long-term respiratory outcomes of children following infant viral bronchiolitis.
- To determine if bronchiolitis predicts later wheezing, independent of atopy.
Main Methods:
- Prospective cohort study comparing 73 children with a history of infant viral bronchiolitis to a matched control group.
- Assessment at 5.5 years of age including respiratory symptom questionnaires and bronchial responsiveness testing to histamine.
- Stepwise logistic regression analysis to identify predictors of wheezing.
Main Results:
- Children with a history of infant bronchiolitis showed a significantly higher prevalence of wheezing (42.5% vs. 15.0%) and other respiratory symptoms compared to controls (Relative Risk = 2.8).
- Infant bronchiolitis remained a significant predictor of wheezing at 5.5 years, even after adjusting for personal atopy.
- Increased bronchial responsiveness to histamine was observed in the post-bronchiolitis group, though not directly correlated with wheezing in this study.
Conclusions:
- Infant viral bronchiolitis is a significant risk factor for developing persistent wheezing and respiratory symptoms in early childhood.
- The association between infant bronchiolitis and later wheezing is independent of personal atopy.
- Further research is needed to understand the mechanisms underlying bronchial hyperresponsiveness post-bronchiolitis.
Abstract:
As part of a long term prospective study, 73 children who had been admitted to hospital with viral bronchiolitis as infants, were reviewed 5.5 years later and compared with a carefully matched control group. In the postbronchiolitis group, there was a highly significant increase in respiratory symptoms including wheezing (42.5% v 15.0%, relative risk = 2.8). Although atopy in the family was not significantly increased in the index group, personal atopy was more prevalent. However, personal atopy was not significantly more prevalent in the symptomatic postbronchiolitis, compared with those who were symptom free, and so did not account for the high prevalence of postbronchiolitis wheezing in this cohort. In addition, in a stepwise logistic regressional model, bronchiolitis remained a significant predictor of wheezing after adjusting for potential confounding variables, including atopy. Bronchial responsiveness to histamine was significantly increased in the index group. However, no significant relationship of positive tests to wheezing could be demonstrated, and a high rate of positive responses was noted in the controls.