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Published on: August 7, 2017
Association between early childhood lower respiratory tract infections and subsequent asthma
Mark S Brittan1,2, Angela Moss2, John D Watson1
1Section of Pediatric Hospital Medicine, Children's Hospital Colorado, University of Colorado Denver, Aurora, CO, USA.
Insights
Recurrent lower respiratory tract infections (LRTI) in children under two are linked to earlier asthma diagnoses. Frequent LRTI hospitalizations significantly increase this risk, highlighting a critical connection for pediatric respiratory health.
Area of Science:
- Pediatric Medicine
- Respiratory Health
- Epidemiology
Background:
- Recurrent lower respiratory tract infections (LRTI) are common in young children.
- The long-term impact of early-life LRTI on subsequent asthma development requires further investigation.
Purpose of the Study:
- To investigate the association between recurrent LRTI in early childhood and the development of pediatric asthma.
- To determine if the frequency and severity of LRTI influence the timing of asthma diagnosis.
Main Methods:
- A retrospective cohort study utilized the Colorado All Payer Claims Database (2009-2017).
- Children aged 0-2 years with LRTI or acute gastroenteritis (AGE) were analyzed.
- Asthma diagnosis (ICD-9/10 codes) between ages 3-9 years was the primary outcome, assessed using multivariable accelerated failure time models.
Main Results:
- Children with 3 or more LRTI visits showed an 80% decrease in median time to asthma diagnosis compared to those with AGE.
- Children with 3 or more LRTI hospitalizations experienced a 98% reduction in median time to asthma diagnosis versus AGE hospitalizations.
- Early atopy, wheezing, and family history of asthma were also associated with earlier asthma diagnosis.
Conclusions:
- Recurrent LRTI in children under two years old is significantly associated with an earlier diagnosis of pediatric asthma.
- LRTI hospitalizations in early childhood are particularly linked to a substantially earlier onset of asthma.
Objective:
We examined the relationship between recurrent lower respiratory tract infections (LRTI) in young children and subsequent childhood asthma outcomes.
Methods:
Retrospective cohort study using 2009-2017 Colorado All Payer Claims Database to assess 0- to 2-year-old children with visits due to LRTI and acute gastroenteritis (AGE). The primary exposure was number of LRTI visits prior to 2 years of age. Children with AGE served as the no LRTI comparator group. The primary outcome was incident asthma, defined by ICD-9 (490.XX) or ICD-10 (J45.9XX) codes, in the same children between 3 and 9 years of age. Multivariable accelerated failure time (AFT) models were used to estimate the effect of LRTI visits on median time to asthma diagnosis. Sensitivity analyses were performed using more conservative asthma diagnostic criteria and with hospitalized children only.
Results:
Of 38,441 eligible subjects, 32,729 had ≥1 LRTI and 5,712 had AGE (no LRTI) between 0 and 2 years of age. Children with ≥3 LRTI visits had an 80% decrease in median time to asthma diagnosis relative to those with AGE visits only (time ratio [TR] 0.2; 95% CI 0.16, 0.24). Children with ≥3 LRTI hospitalizations had a 98% reduction in median time to asthma diagnosis relative to those with AGE hospitalizations only (TR 0.02; 95% CI 0.01, 0.07). History of atopy, wheezing, and family history of asthma documented prior to 2 years of age were also associated with earlier asthma diagnosis.
Conclusions:
Recurrent LRTIs, especially LRTI hospitalizations, before 2 years of age are associated with earlier diagnosis of pediatric asthma.
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