Wheezing rhinovirus illnesses in early life predict asthma development in high-risk children

Abstract

Rationale: Virus-induced wheezing episodes in infancy often precede the development of asthma. Whether infections with specific viral pathogens confer differential future asthma risk is incompletely understood.

Objectives: To define the relationship between specific viral illnesses and early childhood asthma development.

Methods: A total of 259 children were followed prospectively from birth to 6 years of age. The etiology and timing of specific viral wheezing respiratory illnesses during early childhood were assessed using nasal lavage, culture, and multiplex reverse transcriptase-polymerase chain reaction. The relationships of these virus-specific wheezing illnesses and other risk factors to the development of asthma were analyzed.

Measurements and main results: Viral etiologies were identified in 90% of wheezing illnesses. From birth to age 3 years, wheezing with respiratory syncytial virus (RSV) (odds ratio [OR], 2.6), rhinovirus (RV) (OR, 9.8), or both RV and RSV (OR , 10) was associated with increased asthma risk at age 6 years. In Year 1, both RV wheezing (OR, 2.8) and aeroallergen sensitization (OR, 3.6) independently increased asthma risk at age 6 years. By age 3 years, wheezing with RV (OR, 25.6) was more strongly associated with asthma at age 6 years than aeroallergen sensitization (OR, 3.4). Nearly 90% (26 of 30) of children who wheezed with RV in Year 3 had asthma at 6 years of age.

Conclusions: Among outpatient viral wheezing illnesses in infancy and early childhood, those caused by RV infections are the most significant predictors of the subsequent development of asthma at age 6 years in a high-risk birth cohort.

Figures

Figure 1.

Viral etiology of wheezing illnesses in the first 3 years of life in children with and without asthma at age 6 years. Frequency of rhinovirus (RV) wheezing illnesses during the first 3 years of life increased in children with asthma (n = 73) and decreased in children without asthma (n = 186) at age 6 years. AdV = adenovirus; CV = coronaviruses (OC143, NL63, and 0229); EnV = enteroviruses; Flu = influenza types A and B; MPV = metapneumoviruses; PIV = parainfluenza virus types 1–4; RSV = respiratory syncytial virus.

Figure 2.

Risk of asthma at age 6 years in children who wheezed during the first 3 years of life with rhinovirus (RV), respiratory syncytial virus (RSV), or both (*P < 0.05 vs. Neither; +P < 0.05 vs. RSV only). OR = odds ratio.