Predictors of asthma following severe respiratory syncytial virus (RSV) bronchiolitis in early childhood
Susan Lu, Tina V Hartert, Mark L Everard, Hilde Giezek, Linda Nelsen, Anish Mehta, Hima Patel, Barbara Knorr, Theodore F Reiss, Susan Lu, Tina V Hartert, Mark L Everard, Hilde Giezek, Linda Nelsen, Anish Mehta, Hima Patel, Barbara Knorr, Theodore F Reiss
Abstract
Background: We sought to identify predictors of asthma development following severe early childhood RSV bronchiolitis. Different definitions of asthma were also compared.
Methods: This longitudinal, observational study (N = 343) followed patients (<2 years old) from a placebo-controlled trial (N = 979) of montelukast after RSV bronchiolitis to identify clinical, demographic, or biochemical predictors of asthma, atopic disorders, and chronic asthma therapy use at 6 years of age (Clinical Trials Registry Number: NCT01140048). Asthma (primary definition) was based on parental identification of wheeze at 6 AND 12 months before 6 years of age; definitions based on physician diagnosis as well as parental identification of wheeze at 6 OR 12 months (to consider seasonal effect) were also assessed. Post-hoc analyses evaluated agreement among asthma diagnosis criteria.
Results: Prevalence of asthma (primary definition by parental identification), asthma (physician diagnosis), atopic disorders, and chronic asthma therapy use (parental identification) was 6.1%, 22.4%, 36.2%, and 14.5%, respectively. Predictors for asthma (primary definition) included male gender, a relative with asthma, and RAST positive for dog dander; for physician diagnosis of asthma, high severity score for RSV bronchiolitis, high respiratory rate, and asthma diagnosis before enrollment. Predictors of atopic disorders included allergic rhinitis before enrollment, a relative with asthma, and the plasma biomarkers IL-5, IL-16, and IL-18. Predictors of chronic asthma therapy use included asthma diagnosis before enrollment and geographic region (Europe and Africa). Only 42% of patients with asthma (primary definition) also met the asthma definition by physician diagnosis and chronic asthma therapy use.
Conclusion: Among children with early RSV bronchiolitis, hereditary factors (i.e., having a relative with asthma) and RSV bronchiolitis severity were predictors of asthma and atopic disorders at 6 years of age. Of interest, there was poor agreement among the asthma definitions evaluated. Pediatr Pulmonol. 2016;51:1382-1392. © 2016 Wiley Periodicals, Inc.
Keywords: RSV bronchiolitis; asthma; asthma diagnosis; respiratory syncytial virus.
Conflict of interest statement
Conflicts of Interests
SL, HG, LN, AM, HP, BK, and TR are or were employees of Merck & Co., Inc., Kenilworth, NJ.
TH and ME report no conflicts of interest.
© 2016 Wiley Periodicals, Inc.
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Source: PubMed