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Wheezing bronchitis in children. Incidence, viral infections, and other risk factors in a defined population
E Rylander1, M Eriksson, G Pershagen
1Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
Insights
Severe wheezing bronchitis in hospitalized children is common, particularly in young boys. While viral infections are often suspected, atopy may play a larger role in older children without confirmed viral causes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Allergy and Immunology
Background:
- Severe wheezing bronchitis necessitates hospitalization in young children.
- Understanding risk factors is crucial for prevention and management.
Purpose of the Study:
- To identify risk factors for severe wheezing bronchitis in hospitalized children aged 4 months to 4 years.
- To investigate the role of viral etiology and atopy in the disease.
Main Methods:
- A population-based cohort study was conducted in the catchment area of St Göran's hospital, Stockholm.
- Data collected included incidence rates, preceding upper respiratory tract infections, viral isolation, and immunoglobulin E (IgE) levels.
Main Results:
- The incidence was 3/1000 children/year, with higher rates in boys under 18 months.
- 90% had preceding upper respiratory infections, but viral etiology was confirmed in only 26%.
- Atopy, indicated by higher IgE levels, was more significant in older children (>18 months) with negative virus isolation.
Conclusions:
- Viral infections are not always demonstrable in severe wheezing bronchitis, especially in older children.
- Atopy is a significant risk factor for severe wheezing bronchitis in children over 18 months, particularly when viral etiology is not identified.
Abstract:
Risk factors for severe wheezing bronchitis were studied in children aged 4 months to 4 years in need of hospitalization. The children included in the study consisted of all cases generated from a geographically defined population, the catchment area of St Göran's hospital in Stockholm. The incidence was 3/1000 children and year, during the two years of observation, with the highest rate in boys under the age of 18 months (4.7/1000). Symptoms of a preceding upper respiratory tract infection were reported in 90% of the cases, but a viral etiology could only be demonstrated with virus isolation in 26%. Respiratory syncytial virus was the most common finding in younger children. Rhinovirus was primarily seen in older children with a history of previous wheezing. Regardless of whether the cases had a positive or negative virus isolation they showed the same seasonal distribution. Furthermore, there was no difference in risk factors between children with a positive and negative virus isolation. Children older than 18 months with negative virus isolation had higher IgE levels than those with positive isolation, suggesting that atopy is of greater importance in this group.