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Childhood asthma following hospitalization with acute viral bronchiolitis in infancy
1Department of Thoracic Medicine, Royal Children's Hospital, Melbourne, Australia.
Insights
Most infants hospitalized with respiratory syncytial virus bronchiolitis develop asthma-like symptoms. However, bronchial provocation tests did not consistently correlate with clinical asthma in this young age group.
Area of Science:
- Pediatrics
- Pulmonology
- Infectious Diseases
Background:
- Respiratory syncytial virus (RSV) bronchiolitis is a common childhood illness.
- Early RSV infection may be linked to the development of reactive airway disease and asthma.
Purpose of the Study:
- To investigate the long-term respiratory health of infants following RSV bronchiolitis.
- To assess the prevalence of asthma-like symptoms and clinical asthma.
- To evaluate the utility of bronchial provocation tests in this population.
Main Methods:
- Prospective follow-up of 48 infants hospitalized with RSV bronchiolitis.
- Clinical examinations, pulmonary function testing, and histamine challenge tests were performed.
- Data collected over a 5-year period post-initial illness.
Main Results:
- 92% of infants experienced asthma-like symptoms within 5 years.
- 71% showed clinical signs of asthma at follow-up laboratory visits.
- 67% of those tested had a positive histamine challenge, but this did not correlate with clinical asthma or family history of atopy.
Conclusions:
- RSV bronchiolitis is associated with a high cumulative prevalence of asthma-like symptoms in early childhood.
- The relationship between positive bronchial provocation tests and clinical asthma in infants requires further investigation.
- Clinical assessment may be more relevant than histamine challenge for diagnosing asthma in this age group.
Abstract:
A prospective follow-up of 48 infants hospitalized with respiratory syncytial virus bronchiolitis in the first year of life revealed that 44 of these infants had symptoms suggestive of asthma in the 5 years following their initial illness (cumulative prevalence 92%). Symptoms became less frequent and less troublesome during the follow-up period. Thirty-five of these children visited the laboratory for clinical examination, pulmonary function testing, and histamine challenge. Twenty-five children were believed to have clinical evidence of asthma at the time of the laboratory visit (point prevalence 71%). Five children were unable to perform pulmonary function tests; 25 of the remaining 30 (67%) had a positive histamine challenge test. No relationship could be demonstrated between a clinical diagnosis of asthma, a family history of atopy, and the results of histamine challenge testing. These results question the relationship between the results of bronchial provocation tests and clinical asthma in this age group.