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Post-bronchiolitis Use of Asthma Medication: A Prospective 1-year Follow-up Study
Eija Bergroth1, Matilda Aakula, Matti Korppi
1From the *Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland; †Department of Pediatrics, Central Hospital of Central Finland, Jyväskylä, Finland; ‡Department of Pediatrics, Turku University Hospital, Turku, Finland; §Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland; ¶Allergy Centre, Tampere University Hospital, Tampere, Finland; ‖Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; **Department of Molecular Virology and Microbiology and ††Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and ‡‡Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Insights
Rhinovirus bronchiolitis in young children is linked to increased asthma medication use. This study found rhinovirus-positive cases led to more controller medication and corticosteroid use in the year following hospitalization.
Area of Science:
- Pediatric Respiratory Medicine
- Viral Infections
- Asthma Etiology
Background:
- Bronchiolitis is a common respiratory infection in infants.
- Viral pathogens are primary causes of bronchiolitis.
- The long-term respiratory sequelae of bronchiolitis are not fully understood.
Purpose of the Study:
- To investigate the association between specific viral findings in bronchiolitis and subsequent asthma medication use.
- To evaluate the link between viral etiology and systemic corticosteroid use in the year post-bronchiolitis.
Main Methods:
- Prospective, 3-center, 1-year follow-up study of 408 children hospitalized for bronchiolitis (<24 months).
- Viral detection via polymerase chain reaction (PCR) in nasopharyngeal aspirates.
- Structured interviews and questionnaires assessed medication use; multivariable logistic regression analyzed data.
Main Results:
- Rhinovirus-positive bronchiolitis was associated with significantly higher use of long-term asthma controller medication (61% vs. 15% for RSV-positive).
- Adjusted odds ratios indicated a 7.5-fold increased likelihood of controller medication use in rhinovirus-positive cases.
- Rhinovirus etiology also correlated with increased systemic corticosteroid courses and similar findings were observed in infants with first wheezing.
Conclusions:
- Hospitalization for rhinovirus-positive bronchiolitis increases the likelihood of long-term asthma controller medication use in the first year post-hospitalization.
- Rhinovirus may play a significant role in the development of reactive airway disease following infant bronchiolitis.
Background:
Our aim was to evaluate the association between viral findings during bronchiolitis and the use of asthma controller medication (primary outcome) and systemic corticosteroids (secondary outcome) during the first post-bronchiolitis year.
Methods:
We enrolled 408 children hospitalized for bronchiolitis at <24 months of age in a prospective, 3-center, 1-year follow-up study in Finland. Viruses were detected with polymerase chain reaction in nasopharyngeal aspirates. The parents underwent a structured interview during hospitalization. Twelve months later, the use of asthma medication was asked in a structured questionnaire. Multivariable logistic regression was used for statistical analysis.
Results:
In total, 365 (89%) children completed the 1-year follow-up. The use of long-term asthma controller medication was highest in the rhinovirus-positive group (61% vs. 15% in respiratory syncytial virus-positive group; adjusted odd ratios, 7.5; 95% confidence interval: 3.7-15.3), followed by children negative for both respiratory syncytial virus and rhinovirus (36%; adjusted odd ratios, 2.6; 95% confidence interval: 1.3-5.3). Likewise, rhinovirus etiology was associated with more courses of systemic corticosteroids during the follow-up. The main findings were similar in a subset of infants aged <12 months with first wheezing.
Conclusions:
Children hospitalized for rhinovirus-positive bronchiolitis used long-term asthma controller medication more often than those hospitalized for rhinovirus-negative bronchiolitis during first year after hospitalization.
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