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Published on: August 7, 2017
Association between early bronchiolitis and the development of childhood asthma: a meta-analysis
Guizuo Wang1, Dong Han1, Zhengdong Jiang2
1Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China.
Insights
Early life bronchiolitis significantly increases the risk of developing wheezing or asthma later in life. This systematic review and meta-analysis confirms a strong association between infant bronchiolitis and persistent respiratory symptoms.
Area of Science:
- Pediatric Pulmonology
- Epidemiology
- Respiratory Medicine
Background:
- Early life bronchiolitis is a common viral respiratory infection in infants.
- A potential link between infant bronchiolitis and the later development of persistent wheezing or asthma has been hypothesized but remains debated.
- Understanding this association is crucial for identifying children at risk for chronic respiratory conditions.
Purpose of the Study:
- To systematically evaluate the association between bronchiolitis before two years of age and the subsequent risk of late-onset wheezing or asthma.
- To synthesize evidence from existing cohort and case-control studies through meta-analysis.
Main Methods:
- A comprehensive systematic search of PubMed, Embase, and Web of Science databases was conducted for studies published between 1955 and January 2020.
- Included studies were cohort and case-control designs examining the link between early-life bronchiolitis and later wheezing/asthma.
- Data extraction was performed by two independent reviewers, and results were pooled using random-effects or fixed-effects models based on heterogeneity.
Main Results:
- The meta-analysis included 32 studies with 292,844 participants.
- Bronchiolitis before two years of age was significantly associated with an increased risk of subsequent wheezing/asthma (relative risk = 2.46, 95% CI 2.14 to 2.82, p<0.001).
- This association remained significant across various subgroup analyses, including age at follow-up, geographical region, and study quality.
Conclusions:
- The findings indicate a robust association between early-life bronchiolitis and the development of wheezing/asthma in later life.
- Further well-designed, prospective studies are recommended to validate this risk and explore potential confounding factors.
- The identified risk warrants consideration in clinical practice and public health strategies for managing infants with bronchiolitis.
Objective:
Early life bronchiolitis has been hypothesised to be associated with the subsequent risk of persistent wheezing or asthma. However, the link remains controversial. The objective of our study was to evaluate the association between bronchiolitis before 2 years of age and the late-onset wheezing/asthma.
Design:
Systematic review and meta-analysis.
Methods:
PubMed, Embase and Web of Science databases were systematically searched for studies published between 1955 and January 2020. Meanwhile, we also checked through the reference lists of relevant articles to see whether these references included reports of other studies that might be eligible for the review. Cohort and case-control studies assessing the association between early-life bronchiolitis and late-onset wheezing/asthma were included in this meta-analysis. Data were extracted by two independent reviewers. Results were pooled using a random-effects model or fixed-effects model according to the heterogeneity among studies.
Results:
32 original articles with 292 844 participants, which met the criteria, were included in this meta-analysis. Bronchiolitis before 2 years of age was associated with an increased risk of subsequent wheezing/asthma (relative risk=2.46, 95% CI 2.14 to 2.82, p<0.001). After categorising studies into different groups based on age at the end of follow-up, geographical region and study quality, the association still remained significant.
Conclusions:
The meta-analysis indicates an association between bronchiolitis before 2 years of age and the wheezing/asthma in later life. Well-designed and highly standardised prospective studies that better address bias due to potential confounding factors are needed to validate the risk identified in our meta-analysis.PROSPERO registration numberCRD42018089453.
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