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Bronchial asthma and hyperreactivity after early childhood bronchiolitis or pneumonia. An 8-year follow-up study
M Korppi1, L Kuikka, T Reijonen
1Department of Pediatrics, Kuopio (Finland) University Hospital.
Insights
Infantile bronchiolitis and pneumonia increase the risk of childhood asthma and bronchial hyperreactivity, persisting into school age. Early wheezing is a key risk factor for long-term lung issues.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Childhood Respiratory Illnesses
Background:
- Infantile respiratory infections like bronchiolitis and pneumonia are common.
- Long-term respiratory outcomes in children following these infections require further investigation.
- Identifying early risk factors for conditions like asthma is crucial for timely intervention.
Purpose of the Study:
- To assess long-term risks of bronchial asthma and hyperreactivity up to 8-10 years of age.
- To identify infantile risk factors associated with these conditions.
- To evaluate the outcomes in children with a history of early-childhood bronchiolitis or pneumonia.
Main Methods:
- Prospective follow-up of three groups: bronchiolitis, pneumonia (no wheezing), and controls.
- Registration of infantile risk factors until age 2.
- Clinical examination, methacholine challenge test, and lung function tests at 7-8 years of age.
Main Results:
- 15% of children with infantile bronchiolitis developed asthma, compared to 7% with pneumonia and 2% in controls.
- Bronchial hyperreactivity was significantly more common in bronchiolitis (62%) and pneumonia (45%) groups.
- Early onset of wheezing was a significant risk factor for bronchial hyperreactivity; elevated IgE was linked to clinical asthma.
Conclusions:
- Infantile bronchiolitis increases the risk of developing bronchial asthma.
- Both bronchiolitis and pneumonia elevate the risk of bronchial hyperreactivity and long-term lung function abnormalities.
- Methacholine challenge is sensitive but not specific for diagnosing childhood asthma.
Objective:
To determine the infantile risk factors and long-term outcome up to 8 to 10 years of age for bronchial asthma and hyperreactivity in children with early-childhood bronchiolitis or pneumonia.
Design:
Prospective follow-up of three groups of children.
Setting:
University hospital providing primary hospital care and outpatient consultations for all pediatric patients in a defined area.
Interventions:
None.
Patients:
The study groups consisted of 62 children with early-childhood bronchiolitis, 29 children with early-childhood pneumonia with no wheezing, and 52 control children.
Methods:
Infantile risk factors were prospectively registered until 2 years of age. Clinical examination, performed 7 to 8 years later, included recording of atopic and asthmatic symptoms from the preceding 12 months. The methacholine inhalation challenge test was used to assess bronchial hyperreactivity, and mean midexpiratory flow results were used to assess bronchial obstruction.
Main Results:
Bronchial asthma was present in nine (15%) of the 62 children from the bronchiolitis group, compared with 7% in the pneumonia group and 2% in the control group. Bronchial hyperreactivity indicated by methacholine inhalation challenge was far more common; it was present in 62% of the bronchiolitis group and in 45% of the pneumonia group. Both groups differed significantly from the control group. Decreased mean midexpiratory flow values were observed in 29% and 21% of the bronchiolitis and pneumonia groups, respectively. All 10 asthmatic patients had bronchial hyperreactivity, but only 20% of hyperreactive children had asthma. An analysis of infantile risk factors disclosed only one, an early onset of wheezing, with a significant effect on bronchial hyperreactivity at school age. Elevated IgE values measured during infancy were associated with the development of clinical asthma.
Conclusions:
The risk of bronchial asthma was increased after infantile bronchiolitis. Moreover, bronchial hyperreactivity was increased after both infantile bronchiolitis and pneumonia. Methacholine inhalation challenge was a sensitive but nonspecific test for diagnosing bronchial asthma. Both bronchiolitis and pneumonia resulting in hospitalization in early childhood distinguish a group of children with an increased risk for long-term lung function abnormalities and pulmonary illnesses.
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