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Published on: December 10, 2013
Recurrent Wheezing and Asthma After Respiratory Syncytial Virus Bronchiolitis
Yunlian Zhou1, Lin Tong1, Mengyao Li1
1Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Insights
Respiratory syncytial virus (RSV) bronchiolitis can lead to recurrent wheezing and asthma in children. Cesarean section is a risk factor for wheezing, while higher birth weight and older onset age are linked to asthma development.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Allergy and Immunology
Background:
- Respiratory syncytial virus (RSV) is a common cause of acute bronchiolitis in children.
- RSV infection can be a precursor to recurrent wheezing and increase the risk of childhood asthma.
Purpose of the Study:
- To investigate the long-term consequences of RSV-infected bronchiolitis on recurrent wheezing and asthma development.
- To identify risk factors associated with the progression from RSV bronchiolitis to recurrent wheezing and asthma.
Main Methods:
- A cohort of 425 children diagnosed with RSV-infected bronchiolitis was followed long-term.
- Data collected included age of onset, birth weight, mode of delivery (cesarean section), serum IgE levels, and outcomes (recurrent wheezing, asthma, or complete recovery).
- Multiple logistic regression analysis was used to identify risk factors.
Main Results:
- Of 266 children completing follow-up, 36 developed recurrent wheezing (RW) and 65 developed asthma (AS).
- Higher birth weight and older age of onset were observed in the asthma group compared to the completely recovered (CR) group.
- A higher proportion of cesarean sections was noted in the RW group, and elevated serum IgE was found in the AS group.
Conclusions:
- RSV bronchiolitis is associated with an increased incidence of recurrent wheezing and asthma.
- Cesarean section emerged as a risk factor for recurrent wheezing, while higher birth weight and older onset age are risk factors for asthma development.
- Allergic predisposition is crucial for asthma development following RSV bronchiolitis.
Abstract:
Background: Respiratory syncytial virus (RSV) is the most common pathogen of acute bronchiolitis in children, which sometimes triggers the development of recurrent wheezing and increases the risk of childhood asthma. Methods: We enrolled 425 children who were diagnosed with RSV-infected bronchiolitis at the department of pulmonology, Children's Hospital Zhejiang University School of Medicine in 2011. Long-term follow-up was performed to explore the consequence of bronchiolitis on subsequent recurrent wheezing and asthma. Results: Of 425 patients, 266 cases completed the entire follow-up, the mean age of onset was 4.9 (3.3) months, and the male-to-female ratio was 2.5. The mean birth weight of all patients was 3.22 (0.63) kg, and the number of patients who had a history of cesarean section was 148. According to the outcome of follow-up, 36 were in the recurrent wheezing (RW) group, 65 were in the asthma (AS) group, and the remaining 165 were in the completely recovered (CR) group. The age of onset was older and the birth weights were higher in the AS group than those in the CR group (P < 0.05). And the higher proportion of cesarean sections was higher in the RW group than that in the CR group (P < 0.05). Furthermore, we found a remarkable increasing of serum IgE in the AS groups than that in the CR group (P < 0.01). Multiple logistic regression analysis showed that the cesarean section was the risk factor for the development of recurrent wheezing and the higher birth weight was the risk factor for the development of asthma. Conclusion: RSV bronchiolitis might increase the incidence of recurrent wheezing and asthma. Allergic constitution was an important prerequisite for the occurrence of asthma, and related risk factor such as cesarean section can only increase recurrent wheezing to a certain extent within a certain period of time. And we also find higher birth weight and older onset age for those who develop asthma, which should be verified in the future.
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