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Published on: August 7, 2017
Asthma and lung function in adulthood after a viral wheezing episode in early childhood
K Backman1, H Ollikainen2, E Piippo-Savolainen1
1Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland.
Insights
Early childhood wheezing from respiratory syncytial virus (RSV) and rhinovirus (RV) increases adult asthma risk. These viral infections are linked to long-term lung function changes, highlighting the importance of early diagnosis and management.
Area of Science:
- Pediatric Respiratory Medicine
- Infectious Diseases
- Epidemiology
Background:
- Viral infections significantly impact the long-term prognosis of early childhood wheezing.
- Respiratory Syncytial Virus (RSV) and Rhinovirus (RV) are common viral culprits in pediatric respiratory illnesses.
Purpose of the Study:
- To investigate the association between early-childhood wheezing induced by RSV and RV and the development of asthma and lung function abnormalities in adulthood.
- To compare the long-term outcomes of wheezing episodes caused by different viruses.
Main Methods:
- A cohort of 100 children hospitalized for wheezing before 24 months of age were prospectively followed.
- Viral etiology (including RSV and RV) was determined using antigen detection, antibody assays, and PCR.
- Adult lung function was assessed via spirometry with bronchodilation and fractional exhaled nitric oxide (FeNO) measurements in 49 cases and 60 controls.
Main Results:
- Adult asthma prevalence was significantly higher in RV-induced wheezing (64%) and RSV-induced wheezing (43%) compared to controls (12%).
- RV-positive cases exhibited higher FeNO levels and increased bronchial reactivity (higher MEF50, FEV1, FEV1/FVC response to bronchodilation) than RSV-positive cases and controls.
- RSV-positive cases showed lower FVC before bronchodilation compared to controls.
Conclusions:
- Early-childhood wheezing linked to RV and RSV infections elevates the risk of adult asthma.
- RV-induced wheezing is associated with greater bronchial hyperresponsiveness and elevated FeNO, while RSV is linked to reduced FVC in adulthood.
- These findings underscore the lasting impact of viral respiratory infections in infancy on respiratory health outcomes.
Background:
Viral aetiology of infection has a significant role in the long-term outcome of early-childhood wheezing.
Objective:
This study examines asthma and lung function in adulthood after early-childhood wheezing induced by respiratory syncytial virus (RSV) and rhinovirus (RV).
Methods:
A total of 100 children were hospitalized for a wheezing episode at less than 24 months of age from 1992 to 1993 in Kuopio University Hospital (Finland). Adenovirus, influenza A and B virus, parainfluenza (1-3) virus, and RSV were tested on admission using antigen detection and antibody assays, and RSV and RV were tested by polymerase chain reaction (PCR). In 2010, 49 cases and 60 population controls attended a follow-up study, which included spirometry with bronchodilation test and fractionally exhaled nitric oxide (FENO ) measurements.
Results:
Current asthma was present in 64% of the cases with RV-induced wheezing (OR 17.0 [95%CI 3.9-75.3] vs controls), in 43% of the cases with RSV-induced wheezing episode (6.1 [1.5-24.9] vs controls), and in 12% of the controls. The RV group showed significantly higher mean FENO values than the RSV group and controls. RV-positive cases had lower MEF50 before bronchodilation and higher MEF50, FEV1, and FEV1/FVC bronchodilation responses than controls. RSV-positive cases had lower FVC than controls before bronchodilation.
Conclusion:
Cases with RV- and RSV-induced early-childhood wheezing had increased risk for asthma in adulthood, and RV-positive cases had significantly higher FENO values than RSV-positive cases and controls. Compared to controls, RV-positive cases showed more bronchial reactivity, and RSV-positive cases showed lower FVC before bronchodilation in lung function testing.
Clinical Relevance:
Children with RV- or RSV-induced wheezing in early childhood have an increased risk for asthma and lung function abnormalities in adulthood.
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