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[A retrospective survey on the respiratory course of severe bronchiolitis]
1Centre de Diagnostic et de Traitement de l'Asthme de l'Enfant, Hôpital d'Enfants Armand-Trousseau, Paris.
Insights
Severe infant bronchiolitis, especially from respiratory syncytial virus (RSV) infection, increases the risk of developing asthma. Early childhood asthma is linked to RSV, prematurity, allergies, and environmental factors like tobacco smoke.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Allergy and Immunology
Context:
- Infant respiratory syncytial virus (RSV) infection can lead to bronchial hyperresponsiveness and IgE production, potentially predisposing to asthma.
- Severe bronchiolitis in infancy, characterized by apnea, hypercapnia, or hypoxemia, necessitates intensive care and may influence long-term respiratory health.
Purpose:
- To investigate the association between severe infantile bronchiolitis and the subsequent development of asthma.
- To identify risk factors contributing to asthma development following severe early-life respiratory infections.
Summary:
- A retrospective study of 43 infants with severe bronchiolitis requiring intensive care found that 26 of 41 survivors developed recurrent wheezing.
- Asthma developed in 15 patients, with significant correlations observed with RSV infection, bronchopulmonary dysplasia, history of allergies, close contact with other children, and tobacco exposure.
- The severity of the initial bronchiolitis episode was also found to be correlated with the risk of developing asthma.
Impact:
- This research highlights critical risk factors for childhood asthma, emphasizing the long-term consequences of severe RSV infections and bronchiolitis.
- Findings underscore the importance of early intervention and preventative strategies for infants experiencing severe respiratory distress to mitigate future asthma risk.
Background:
Respiratory syncytial virus (RSV) infection in infancy can induce bronchial reactivity and virus-specific IgE production; these responses may favor the later development of asthma. This retrospective study examines the influences of early and severe forms of bronchiolitis on such an outcome.
Population And Methods:
The files of 43 infants who had spent 1 to 24 days (mean 7.8 days) in intensive care between 1986-1990 for severe bronchiolitis with apnea and/or hypercapnia and/or hypoxemia were studied. The parents of all these children agreed to answer a standard questionnaire covering perinatal events, gestational age, number and frequency of recurrent episodes of wheezing, personal and familial history of allergy and environmental conditions. 15 of the children were preterm and 12 of them were given respiratory support during the neonatal period; 5 of these patients developed broncho-pulmonary dysplasia. RSV was isolated in 20 of 39 patients.
Results:
26 of the 41 surviving patients developed at least 3 episodes of wheezing over periods ranging from 5 to 54 months (mean 27.6 months): 15 of them were admitted at least once for asthma and 17 were given long-term bronchodilators and/or corticosteroids. Of the 8 patients with histories of allergy, 6 developed asthma, as did 7 of the 9 that had been in close contact with other children, and 9 of the 15 patients who had been exposed to tobacco.
Conclusions:
Not only is the development of asthma associated with risk factors (RSV infection, bronchopulmonary dysplasia, history of allergy, close contact with other children and exposure to tobacco) but the severity of the bronchiolitis per se is also correlated with this risk.