Severe bronchiolitis in infancy: can asthma in adolescence be predicted?

Area of Science:

• Pediatrics
• Respiratory Medicine
• Epidemiology

Background:

• Bronchiolitis in infancy is a known risk factor for developing asthma later in life.
• Predicting childhood asthma after infant bronchiolitis can be challenging, despite many children being asymptomatic at school age.

Purpose of the Study:

• To determine if simple clinical variables at 2 years of age can predict asthma at 11 years.
• To establish a basis for follow-up and treatment strategies for infants with bronchiolitis.

Main Methods:

• A cohort of 105 infants hospitalized for bronchiolitis was followed.
• Clinical variables were assessed at 2 years of age, with follow-ups at 2 and 11 years of age.
• Asthma diagnosis at 11 years was the primary outcome, analyzed against early clinical predictors.

Main Results:

• The prevalence of asthma at 11 years was 22.6%.
• Recurrent wheeze at 2 years was a significant predictor (OR 7.2), with high sensitivity but low specificity for asthma.
• Combining recurrent wheeze with parental atopy, parental asthma, or atopic dermatitis improved predictive specificity and positive likelihood ratios.

Conclusions:

• Simple, non-invasive clinical variables assessed at 2 years can predict childhood asthma following infant bronchiolitis.
• Recurrent wheeze is a key indicator, but its absence is more effective at excluding than predicting later asthma.
• Combining recurrent wheeze with family history or atopic dermatitis enhances prediction accuracy for identifying children at risk of developing asthma.