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Risk factors for recurrent wheezing after bronchiolitis

Y H Fan¹, P L Zhang¹, Y J Huang²

¹Department of Pediatric Pulmonary Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.

|June 23, 2023

Insights

Children hospitalized for bronchiolitis with a history of allergies, atopic dermatitis, allergic rhinitis, or family history of atopy are at higher risk for recurrent wheezing. Moraxella catarrhalis infection also plays a role.

Area of Science:

Pediatrics
Allergy and Immunology
Respiratory Medicine

Background:

Bronchiolitis is a common respiratory infection in infants.
A subset of children who experience bronchiolitis develop recurrent wheezing.
Identifying risk factors for recurrent wheezing is crucial for early intervention.

Purpose of the Study:

To investigate the association between various factors and the development of recurrent wheezing in children after bronchiolitis.
To identify independent risk factors for recurrent wheezing in this population.

Main Methods:

A cohort of 167 children hospitalized for bronchiolitis was studied.
Patients were categorized into recurrent wheezing (RWG) and non-recurrent wheezing (NRWG) groups.
Statistical analyses, including t-tests, Mann-Whitney U-tests, chi-square tests, and logistic regression, were employed to compare risk factors.

Main Results:

Children in the RWG had higher maternal age and a greater likelihood of allergic history, atopic dermatitis, allergic rhinitis, and atopic family history.
Moraxella catarrhalis was more prevalent in the RWG.
Atopic dermatitis, allergic rhinitis, and atopic family history were identified as independent risk factors for recurrent wheezing.

Conclusions:

Allergic history, Moraxella catarrhalis infection, atopic dermatitis, allergic rhinitis, and atopic family history are associated with recurrent wheezing post-bronchiolitis.
Atopic dermatitis, allergic rhinitis, and atopic family history are significant independent risk factors.

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Abstract

Background:

This study aimed to determine whether there was an association between certain factors in patients with bronchiolitis and recurrent wheezing in childhood.

Method:

In 2021 we tracked children hospitalized for bronchiolitis at Chengdu Women's and Children's Central Hospital in 2017. The patients were classified into recurrent wheezing group (RWG) and non-recurrent wheezing group (NRWG). Possible risk factors including maternal age, school-age siblings, allergic history, atopic dermatitis, allergic rhinitis, atopic family history, severity of the condition, duration of hospitalization, nasopharyngeal secretions culture, blood eosinophil counts, FeNO and skin prick test were compared between the two groups. Continuous variables were analyzed by independent sample t-test for normal distribution and Mann-Whitney U-test for non-normal distribution. Categorical variables were tested using chi-square tests. Multifactor analysis was conducted by stepwise logistics regression analysis.

Results:

In total 167 participants were included, of which 26 and 141 were in RWG and NRWG respectively. In RWG children represented higher maternal age (P = 0.02) and greater probability of allergic history, atopic dermatitis, allergic rhinitis, atopic family history (odds ratio [OR] = 4.0,3.7, 7.8, 10.9 respectively, P < 0.01). However, school-age siblings, severity of the condition, duration of hospitalization, blood eosinophil counts, fractional exhaled nitric oxide and skin prick test results seemed unrelated to recurrent wheezing. In the subgroup analysis of nasopharyngeal secretion culture, there were more Moraxella catarrhalis-positive in RWG(P = 0.043). Atopic dermatitis, allergic rhinitis and atopic family history were identified as independent risk factors for recurrent wheezing.

Conclusion:

Some children with bronchiolitis will develop recurrent wheezing, and the risk factors are allergic history, Moraxella catarrhalis infection or colonization, atopic dermatitis, allergic rhinitis and atopic family history; the latter three are independent risk factors.

Keywords:

Bronchiolitis Infant Recurrent wheezing

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