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Akagawa S, Kaneko K. Gut microbiota and allergic diseases in children. Allergol Int 2022; 71:301-309. [PMID: 35314107 DOI: 10.1016/j.alit.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/28/2022] [Accepted: 02/10/2022] [Indexed: 12/11/2022] Open
Abstract
The gut microbiota resides in the human gastrointestinal tract, where it plays an important role in maintaining host health. The human gut microbiota is established by the age of 3 years. Studies have revealed that an imbalance in the gut microbiota, termed dysbiosis, occurs due to factors such as cesarean delivery and antibiotic use before the age of 3 years and that dysbiosis is associated with a higher risk of future onset of allergic diseases. Recent advancements in next-generation sequencing methods have revealed the presence of dysbiosis in patients with allergic diseases, which increases attention on the relationship between dysbiosis and the development of allergic diseases. However, there is no unified perspective on the characteristics on dysbiosis or the mechanistic link between dysbiosis and the onset of allergic diseases. Here, we introduce the latest studies on the gut microbiota in children with allergic diseases and present the hypothesis that dysbiosis characterized by fewer butyric acid-producing bacteria leads to fewer regulatory T cells, resulting in allergic disease. Further studies on correcting dysbiosis for the prevention and treatment of allergic diseases are warranted.
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Affiliation(s)
- Shohei Akagawa
- Department of Pediatrics, Kansai Medical University, Osaka, Japan
| | - Kazunari Kaneko
- Department of Pediatrics, Kansai Medical University, Osaka, Japan.
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2
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Heikkilä P, Korppi M, Ruotsalainen M, Backman K. Viral wheezing in early childhood as a risk factor for asthma in young adulthood: A prospective long‐term cohort study. Health Sci Rep 2022; 5:e538. [PMID: 35284656 PMCID: PMC8900980 DOI: 10.1002/hsr2.538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/25/2022] [Accepted: 02/06/2022] [Indexed: 10/26/2022] Open
Affiliation(s)
- Paula Heikkilä
- Department of Pediatrics, Tampere Center for Child Health Research, Faculty of Medicine and Health Technology Tampere University and Tampere University Hospital Tampere Finland
- Institute of Clinical Medicine University of Eastern Finland Kuopio Finland
| | - Matti Korppi
- Department of Pediatrics, Tampere Center for Child Health Research, Faculty of Medicine and Health Technology Tampere University and Tampere University Hospital Tampere Finland
| | - Marja Ruotsalainen
- Department of Pediatrics Kuopio University Hospital and University of Eastern Finland Kuopio Finland
| | - Katri Backman
- Department of Pediatrics Kuopio University Hospital and University of Eastern Finland Kuopio Finland
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Kengne–Nde C, Kenmoe S, Modiyinji AF, Njouom R. Prevalence of respiratory viruses using polymerase chain reaction in children with wheezing, a systematic review and meta-analysis. PLoS One 2020; 15:e0243735. [PMID: 33315873 PMCID: PMC7735590 DOI: 10.1371/journal.pone.0243735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 11/26/2020] [Indexed: 01/12/2023] Open
Abstract
Introduction Wheezing is a major problem in children, and respiratory viruses are often believed to be the causative agent. While molecular detection tools enable identification of respiratory viruses in wheezing children, it remains unclear if and how these viruses are associated with wheezing. The objective of this systematic review is to clarify the prevalence of different respiratory viruses in children with wheezing. Methods We performed an electronic in Pubmed and Global Index Medicus on 01 July 2019 and manual search. We performed search of studies that have detected common respiratory viruses in children ≤18 years with wheezing. We included only studies using polymerase chain reaction (PCR) assays. Study data were extracted and the quality of articles assessed. We conducted sensitivity, subgroup, publication bias, and heterogeneity analyses using a random effects model. Results The systematic review included 33 studies. Rhinovirus, with a prevalence of 35.6% (95% CI 24.6–47.3, I2 98.4%), and respiratory syncytial virus, at 31.0% (95% CI 19.9–43.3, I2 96.4%), were the most common viruses detected. The prevalence of other respiratory viruses was as follows: human bocavirus 8.1% (95% CI 5.3–11.3, I2 84.6%), human adenovirus 7.7% (95% CI 2.6–15.0, I2 91.0%), influenza virus6.5% (95% CI 2.2–12.6, I2 92.4%), human metapneumovirus5.8% (95% CI 3.4–8.8, I2 89.0%), enterovirus 4.3% (95% CI 0.1–12.9, I2 96.2%), human parainfluenza virus 3.8% (95% CI 1.5–6.9, I2 79.1%), and human coronavirus 2.2% (95% CI 0.6–4.4, I2 79.4%). Conclusions Our results suggest that rhinovirus and respiratory syncytial virus may contribute to the etiology of wheezing in children. While the clinical implications of molecular detection of respiratory viruses remains an interesting question, this study helps to illuminate the potential of role respiratory viruses in pediatric wheezing. Review registration PROSPERO, CRD42018115128.
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Affiliation(s)
- Cyprien Kengne–Nde
- National AIDS Control Committee, Epidemiological Surveillance, Evaluation and Research Unit, Yaounde, Cameroon
| | - Sebastien Kenmoe
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Abdou Fatawou Modiyinji
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
- Faculty of Sciences, Department of Animals Biology and Physiology, University of Yaoundé I, Yaoundé, Cameroon
| | - Richard Njouom
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
- * E-mail: njouom@pasteur–yaounde.org,
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Raita Y, Camargo CA, Bochkov YA, Celedón JC, Gern JE, Mansbach JM, Rhee EP, Freishtat RJ, Hasegawa K. Integrated-omics endotyping of infants with rhinovirus bronchiolitis and risk of childhood asthma. J Allergy Clin Immunol 2020; 147:2108-2117. [PMID: 33197460 DOI: 10.1016/j.jaci.2020.11.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/24/2020] [Accepted: 11/02/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Young children with rhinovirus (RV) infection-particularly bronchiolitis-are at high risk for developing childhood asthma. Emerging evidence suggests clinical heterogeneity within RV bronchiolitis. However, little is known about these biologically distinct subgroups (endotypes) and their relations with asthma risk. OBJECTIVE We aimed to identify RV bronchiolitis endotypes and examine their longitudinal relations with asthma risk. METHODS As part of a multicenter prospective cohort study of infants (age <12 months) hospitalized for bronchiolitis, we integrated clinical, RV species (RV-A, RV-B, and RV-C), nasopharyngeal microbiome (16S rRNA gene sequencing), cytokine, and metabolome (liquid chromatography tandem mass spectrometry) data collected at hospitalization. We then applied network and clustering approaches to identify bronchiolitis endotypes. We also examined their longitudinal association with risks of developing recurrent wheeze by age 3 years and asthma by age 5 years. RESULTS Of 122 infants hospitalized for RV bronchiolitis (median age, 4 months), we identified 4 distinct endotypes-mainly characterized by RV species, microbiome, and type 2 cytokine (T2) response: endotype A, virusRV-CmicrobiomemixedT2low; endotype B, virusRV-AmicrobiomeHaemophilusT2low; endotype C, virusRSV/RVmicrobiomeStreptococcusT2low; and endotype D, virusRV-CmicrobiomeMoraxellaT2high. Compared with endotype A infants, endotype D infants had a significantly higher rate of recurrent wheeze (33% vs 64%; hazard ratio, 2.23; 95% CI, 1.00-4.96; P = .049) and a higher risk for developing asthma (28% vs 59%; odds ratio, 3.74: 95% CI, 1.21-12.6; P = .03). CONCLUSIONS Integrated-omics analysis identified biologically meaningful RV bronchiolitis endotypes in infants, such as one characterized by RV-C infection, Moraxella-dominant microbiota, and high T2 cytokine response, at higher risk for developing recurrent wheeze and asthma. This study should facilitate further research toward validating our inferences.
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Affiliation(s)
- Yoshihiko Raita
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Yury A Bochkov
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Juan C Celedón
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pa
| | - James E Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Jonathan M Mansbach
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Eugene P Rhee
- Nephrology Division and Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Robert J Freishtat
- Division of Emergency Medicine, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Genomics and Precision Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
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5
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Driscoll AJ, Arshad SH, Bont L, Brunwasser SM, Cherian T, Englund JA, Fell DB, Hammitt LL, Hartert TV, Innis BL, Karron RA, Langley GE, Mulholland EK, Munywoki PK, Nair H, Ortiz JR, Savitz DA, Scheltema NM, Simões EAF, Smith PG, Were F, Zar HJ, Feikin DR. Does respiratory syncytial virus lower respiratory illness in early life cause recurrent wheeze of early childhood and asthma? Critical review of the evidence and guidance for future studies from a World Health Organization-sponsored meeting. Vaccine 2020; 38:2435-2448. [PMID: 31974017 PMCID: PMC7049900 DOI: 10.1016/j.vaccine.2020.01.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/20/2019] [Accepted: 01/07/2020] [Indexed: 12/21/2022]
Abstract
Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI) and hospitalization in infants and children globally. Many observational studies have found an association between RSV LRTI in early life and subsequent respiratory morbidity, including recurrent wheeze of early childhood (RWEC) and asthma. Conversely, two randomized placebo-controlled trials of efficacious anti-RSV monoclonal antibodies (mAbs) in heterogenous infant populations found no difference in physician-diagnosed RWEC or asthma by treatment group. If a causal association exists and RSV vaccines and mAbs can prevent a substantial fraction of RWEC/asthma, the full public health value of these interventions would markedly increase. The primary alternative interpretation of the observational data is that RSV LRTI in early life is a marker of an underlying predisposition for the development of RWEC and asthma. If this is the case, RSV vaccines and mAbs would not necessarily be expected to impact these outcomes. To evaluate whether the available evidence supports a causal association between RSV LRTI and RWEC/asthma and to provide guidance for future studies, the World Health Organization convened a meeting of subject matter experts on February 12-13, 2019 in Geneva, Switzerland. After discussing relevant background information and reviewing the current epidemiologic evidence, the group determined that: (i) the evidence is inconclusive in establishing a causal association between RSV LRTI and RWEC/asthma, (ii) the evidence does not establish that RSV mAbs (and, by extension, future vaccines) will have a substantial effect on these outcomes and (iii) regardless of the association with long-term childhood respiratory morbidity, severe acute RSV disease in young children poses a substantial public health burden and should continue to be the primary consideration for policy-setting bodies deliberating on RSV vaccine and mAb recommendations. Nonetheless, the group recognized the public health importance of resolving this question and suggested good practice guidelines for future studies.
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Affiliation(s)
- Amanda J Driscoll
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W. Baltimore St, Suite 480, Baltimore, MD, USA
| | - S Hasan Arshad
- The David Hide Asthma and Allergy Research Centre, St. Mary's Hospital, Newport PO30 5TG, Isle of Wight, UK; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Louis Bont
- The ReSViNET Foundation, Zeist, the Netherlands; Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, Utrecht, the Netherlands; Department of Translational Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, Utrecht, the Netherlands
| | - Steven M Brunwasser
- Center for Asthma Research, Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 450, Nashville, TN 37203, USA
| | - Thomas Cherian
- MM Global Health Consulting, Chemin Maurice Ravel 11C, 1290 Versoix, Switzerland
| | - Janet A Englund
- Seattle Children's Hospital, 4800 Sand Point Way NE Seattle, WA 98105, USA; Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, CPCR, Room L-1154, Ottawa, Ontario K1H 8L1, Canada
| | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA
| | - Tina V Hartert
- Center for Asthma Research, Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 450, Nashville, TN 37203, USA
| | - Bruce L Innis
- Center for Vaccine Innovation and Access, PATH, 455 Massachusetts Avenue NW, Suite 1000, WA, DC 20001, USA
| | - Ruth A Karron
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Suite 217, Baltimore, MD 21205, USA
| | - Gayle E Langley
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - E Kim Mulholland
- Murdoch Children's Research Institute, Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Flemington Rd, Parkville, VIC 3052, Australia; Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
| | - Patrick K Munywoki
- Division of Global Health Protection, US Centers for Disease Control and Prevention, PO Box 606-00621, Nairobi, Kenya
| | - Harish Nair
- The ReSViNET Foundation, Zeist, the Netherlands; Centre for Global Health Research, Usher Institute, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, Scotland, United Kingdom
| | - Justin R Ortiz
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W. Baltimore St, Suite 480, Baltimore, MD, USA
| | - David A Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02903, USA
| | - Nienke M Scheltema
- Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, Utrecht, the Netherlands
| | - Eric A F Simões
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, and Children's Hospital Colorado 13123 E. 16th Ave, B065, Aurora, CO 80045, USA; Department of Epidemiology, Center for Global Health Colorado School of Public Health, 13001 E 17th Pl B119, Aurora, CO 80045, USA
| | - Peter G Smith
- Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
| | - Fred Were
- Department of Pediatrics and Child Health, University of Nairobi, P.O. Box 30197, GPO, Nairobi, Kenya
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; SA-Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, 5th Floor ICH Building, Klipfontein Road, Cape Town, South Africa
| | - Daniel R Feikin
- Department of Immunizations, Vaccines and Biologicals, World Health Organization, 20 Avenue Appia, Geneva, Switzerland
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Hasegawa K, Mansbach JM, Bochkov YA, Gern JE, Piedra PA, Bauer CS, Teach SJ, Wu S, Sullivan AF, Camargo CA. Association of Rhinovirus C Bronchiolitis and Immunoglobulin E Sensitization During Infancy With Development of Recurrent Wheeze. JAMA Pediatr 2019; 173:544-552. [PMID: 30933255 PMCID: PMC6547078 DOI: 10.1001/jamapediatrics.2019.0384] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
IMPORTANCE Rhinovirus infection in early life, particularly with allergic sensitization, is associated with higher risks of developing recurrent wheeze and asthma. While emerging evidence links different rhinovirus species (eg, rhinovirus C) to a higher severity of infection and asthma exacerbation, to our knowledge, little is known about longitudinal associations of rhinovirus C infection during infancy with subsequent morbidities. OBJECTIVE To examine the association of different viruses (respiratory syncytial virus [RSV], rhinovirus species) in bronchiolitis with risks of developing recurrent wheeze. DESIGN, SETTING, AND PARTICIPANTS This multicenter prospective cohort study of infants younger than 1 year who were hospitalized for bronchiolitis was conducted at 17 hospitals across 14 US states during 3 consecutive fall to winter seasons (2011-2014). EXPOSURES Major causative viruses of bronchiolitis, including RSV (reference group) and 3 rhinovirus species (rhinovirus A, B, and C). MAIN OUTCOMES AND MEASURES Development of recurrent wheeze (as defined in national asthma guidelines) by age 3 years. RESULTS This analytic cohort comprised 716 infants who were hospitalized for RSV-only or rhinovirus bronchiolitis. The median age was 2.9 months (interquartile range, 1.6-3.8 months), 541 (76%) had bronchiolitis with RSV only, 85 (12%) had rhinovirus A, 12 (2%) had rhinovirus B, and 78 (11%) had rhinovirus C infection. Overall, 231 (32%) developed recurrent wheeze by age 3 years. In the multivariable Cox model, compared with infants with RSV-only infection, the risk of recurrent wheeze was not significantly different in those with rhinovirus A or B (rhinovirus A: hazard ratio [HR], 1.27; 95% CI, 0.86-1.88; rhinovirus B: HR, 1.39; 95% CI, 0.51-3.77; both P > .10). By contrast, infants with rhinovirus C had a significantly higher risk (HR, 1.58; 95% CI, 1.08-2.32). There was a significant interaction between virus groups and IgE sensitization on the risk of recurrent wheeze (P for interaction < .01). Only infants with both rhinovirus C infection and IgE sensitization (to food or aeroallergens) during infancy had significantly higher risks of recurrent wheeze (HR, 3.03; 95% CI, 1.20-7.61). Furthermore, compared with RSV-only, rhinovirus C infection with IgE sensitization was associated with significantly higher risks of recurrent wheeze with subsequent development of asthma at age 4 years (HR, 4.06; 95% CI, 1.17-14.1). CONCLUSIONS AND RELEVANCE This multicenter cohort study of infants hospitalized for bronchiolitis demonstrated between-virus differences in the risk of developing recurrent wheeze. Infants with rhinovirus C infection, along with IgE sensitization, had the highest risk. This finding was driven by the association with a subtype of recurrent wheeze: children with subsequent development of asthma.
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Affiliation(s)
- Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jonathan M. Mansbach
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yury A. Bochkov
- Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - James E. Gern
- Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Pedro A. Piedra
- Department of Molecular Virology and Microbiology and Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Cindy S. Bauer
- Division of Allergy and Immunology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Stephen J. Teach
- Division of Emergency Medicine and Department of Pediatrics, Children’s National Health System, Washington, DC
| | - Susan Wu
- Division of Hospital Medicine, Children's Hospital of Los Angeles, Los Angeles, California
| | - Ashley F. Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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Abstract
OBJECTIVE The aim of this study was to determine if there is an association between bronchiolitis and future development of asthma in children younger than 2 years. METHODS We reviewed the medical records of 1991 patients younger than 2 years presenting to the emergency department from January 2000 to December 2010 who received a clinical diagnosis of acute bronchiolitis. Their demographic information, the number of bronchiolitis episodes, and family history of asthma were recorded. The primary care clinic records of these children were reviewed for a period of 1 year following their presentation to the emergency department to determine if they had received a diagnosis of asthma. A stepwise logistic regression was performed to determine what factors were associated with future asthma development. RESULTS We reviewed the medical record of 1991 children with the diagnosis of bronchiolitis for subsequent development of asthma. The following variables were identified as predictors of subsequent asthma: male sex (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.05-1.55), family history of asthma (OR, 1.6; 95% CI, 1.33-1.95), atopy (OR, 1.4; 95% CI, 1.12-1.83), age older than 5 months (OR, 1.4 95% CI, 1.13-1.66), more than 2 episodes of bronchiolitis (OR, 2.4; 95% CI, 1.79-3.07), and allergies (OR1.6; 95% CI, 1.14-2.14). CONCLUSIONS In this limited sample, the predictor variables for asthma were male sex, age older than 5 months, more than 2 episodes of bronchiolitis, a history of atopy, and allergies.
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Gaffin JM, Phipatanakul W. The Calculated Risk of Childhood Asthma From Severe Bronchiolitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 5:97-98. [PMID: 28065346 DOI: 10.1016/j.jaip.2016.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 10/18/2016] [Indexed: 01/28/2023]
Affiliation(s)
- Jonathan M Gaffin
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Wanda Phipatanakul
- Department of Pediatrics, Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass.
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Alarcón-Andrade G, Cifuentes L. Do inhaled corticosteroids have a role for bronchiolitis? Medwave 2018; 18:e7183. [PMID: 29677180 DOI: 10.5867/medwave.2018.02.7182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 12/29/2017] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Bronchiolitis consists of an acute small airways inflammation secondary to a viral infection and is a frequent pathology among children under 2 years. The use of inhaled corticosteroids during bronchiolitis has been proposed to reduce recurrent wheeze or asthma, however there is controversy about it. METHODS To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified three systematic reviews including 11 randomized trials. We concluded that inhaled corticosteroids do not reduce recurrent wheeze or asthma in patients with bronchiolitis.
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Affiliation(s)
- Gonzalo Alarcón-Andrade
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
| | - Lorena Cifuentes
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Centro de Evidencia UC, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Centro de Innovación UC Anacleto Angelini, Avda. Vicuña Mackenna 4860, Macul, Santiago, Chile
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Backman K, Ollikainen H, Piippo-Savolainen E, Nuolivirta K, Korppi M. Asthma and lung function in adulthood after a viral wheezing episode in early childhood. Clin Exp Allergy 2017; 48:138-146. [PMID: 29143374 DOI: 10.1111/cea.13062] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 11/08/2017] [Accepted: 11/10/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Viral aetiology of infection has a significant role in the long-term outcome of early-childhood wheezing. OBJECTIVE This study examines asthma and lung function in adulthood after early-childhood wheezing induced by respiratory syncytial virus (RSV) and rhinovirus (RV). METHODS A total of 100 children were hospitalized for a wheezing episode at less than 24 months of age from 1992 to 1993 in Kuopio University Hospital (Finland). Adenovirus, influenza A and B virus, parainfluenza (1-3) virus, and RSV were tested on admission using antigen detection and antibody assays, and RSV and RV were tested by polymerase chain reaction (PCR). In 2010, 49 cases and 60 population controls attended a follow-up study, which included spirometry with bronchodilation test and fractionally exhaled nitric oxide (FENO ) measurements. RESULTS Current asthma was present in 64% of the cases with RV-induced wheezing (OR 17.0 [95%CI 3.9-75.3] vs controls), in 43% of the cases with RSV-induced wheezing episode (6.1 [1.5-24.9] vs controls), and in 12% of the controls. The RV group showed significantly higher mean FENO values than the RSV group and controls. RV-positive cases had lower MEF50 before bronchodilation and higher MEF50, FEV1, and FEV1/FVC bronchodilation responses than controls. RSV-positive cases had lower FVC than controls before bronchodilation. CONCLUSION Cases with RV- and RSV-induced early-childhood wheezing had increased risk for asthma in adulthood, and RV-positive cases had significantly higher FENO values than RSV-positive cases and controls. Compared to controls, RV-positive cases showed more bronchial reactivity, and RSV-positive cases showed lower FVC before bronchodilation in lung function testing. CLINICAL RELEVANCE Children with RV- or RSV-induced wheezing in early childhood have an increased risk for asthma and lung function abnormalities in adulthood.
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Affiliation(s)
- K Backman
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - H Ollikainen
- Child Welfare Clinic and School Health Care, Health Care Center, Pediatrics, Kuopio, Finland
| | | | - K Nuolivirta
- Department of Pediatrics, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - M Korppi
- Pediatric Research Centre, Tampere University and Tampere University Hospital, Tampere, Finland
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Rodríguez-Martínez CE, Sossa-Briceño MP, Castro-Rodriguez JA. Factors predicting persistence of early wheezing through childhood and adolescence: a systematic review of the literature. J Asthma Allergy 2017; 10:83-98. [PMID: 28392707 PMCID: PMC5376126 DOI: 10.2147/jaa.s128319] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background For the early identification of persistent asthma symptoms among young children with recurrent wheezing, it would be helpful to identify all available studies that have identified at least one factor for predicting the persistence of early wheezing. The objective of the present study was to perform a systematic review of all studies that have identified factors that predict the persistence of symptoms among young patients with recurring wheezing. Methods A systematic review of relevant studies was conducted through searching in MEDLINE, EMBASE, CINHAL, and SCOPUS databases up to June 2016. Studies that identified predictors of persistence of wheezing illness among young children with recurrent wheezing were retrieved. Two independent reviewers screened the literature and extracted relevant data. Results The literature search returned 649 references, 619 of which were excluded due to their irrelevance. Five additional studies were identified from reference lists, and 35 studies were finally included in the review. Among all the identified predictors, the most frequently identified ones were the following: family asthma or atopy; personal history of atopic diseases; allergic sensitization early in life; and frequency, clinical pattern, or severity of wheezing/symptoms. Conclusion Parental asthma (especially maternal), parental allergy, eczema, allergic rhinitis, persistent wheezing, wheeze without colds, exercise-induced wheeze, severe wheezing episodes, allergic sensitization (especially polysensitization), eosinophils (blood or eosinophil cationic protein in nasal sample), and fraction of exhaled nitric oxide were risk factors predicting persistence of early wheezing through school age. All of them are included in conventional algorithms, for example, Asthma Predictive Index and its modifications, for predicting future asthma.
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Affiliation(s)
- Carlos E Rodríguez-Martínez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia; Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine, Universidad El Bosque, Bogota, Colombia
| | - Monica P Sossa-Briceño
- Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
| | - Jose A Castro-Rodriguez
- Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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12
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Balekian DS, Linnemann RW, Hasegawa K, Thadhani R, Camargo CA. Cohort Study of Severe Bronchiolitis during Infancy and Risk of Asthma by Age 5 Years. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:92-96. [PMID: 27523277 DOI: 10.1016/j.jaip.2016.07.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Severe bronchiolitis (ie, bronchiolitis requiring hospital admission) is thought to markedly increase asthma risk, with 30%-50% developing asthma by age 5 years. To date, studies of this association are small, and most are from outside the United States. OBJECTIVE The objective of this study was to investigate the association between severe bronchiolitis and risk of asthma in a US birth cohort. METHODS We studied a cohort nested within the Massachusetts General Hospital Obstetric Maternal Study (MOMS), a prospective cohort of pregnant women enrolled during 1998-2006. Children of mothers enrolled in MOMS were included in the analysis if they received care within our health system (n = 3653). Diagnoses and medications were extracted from the children's electronic health records; we also examined pregnancy and perinatal risk factors collected for the underlying pregnancy study. RESULTS The birth cohort was 52% male, 49% white, and 105 infants (2.9%) had severe bronchiolitis. Overall, 421 children (11.5%) developed asthma by age 5 years. Among the children with severe bronchiolitis, 27.6% developed asthma by age 5 years. In multivariable logistic regression adjusting for 12 risk factors, severe bronchiolitis remained a strong risk factor for developing asthma by age 5 years (odds ratio 2.57; 95% confidence interval 1.61-4.09). CONCLUSIONS In a large Boston birth cohort, the frequency of severe bronchiolitis and childhood asthma was similar to published data. Among children with severe bronchiolitis, the risk of developing asthma was lower than prior studies but still high (27.6%). This difference may be due to different study designs, populations, and outcome definitions studied.
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Affiliation(s)
- Diana S Balekian
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Rachel W Linnemann
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Kohei Hasegawa
- Harvard Medical School, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass
| | - Ravi Thadhani
- Harvard Medical School, Boston, Mass; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Carlos A Camargo
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass.
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13
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Garcia-Garcia ML, Calvo Rey C, Del Rosal Rabes T. Pediatric Asthma and Viral Infection. Arch Bronconeumol 2016; 52:269-73. [PMID: 26766408 PMCID: PMC7105201 DOI: 10.1016/j.arbres.2015.11.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/06/2015] [Accepted: 11/09/2015] [Indexed: 12/15/2022]
Abstract
Respiratory viral infections, particularly respiratory syncytial virus (RSV) and rhinovirus, are the most importance risk factors for the onset of wheezing in infants and small children. Bronchiolitis is the most common acute respiratory infection in children under 1year of age, and the most common cause of hospitalization in this age group. RSV accounts for approximately 70% of all these cases, followed by rhinovirus, adenovirus, metapneumovirus and bocavirus. The association between bronchiolitis caused by RSV and the development of recurrent wheezing and/or asthma was first described more than 40years ago, but it is still unclear whether bronchiolitis causes chronic respiratory symptoms, or if it is a marker for children with a genetic predisposition for developing asthma in the medium or long term. In any case, sufficient evidence is available to corroborate the existence of this association, which is particularly strong when the causative agent of bronchiolitis is rhinovirus. The pathogenic role of respiratory viruses as triggers for exacerbations in asthmatic patients has not been fully characterized. However, it is clear that respiratory viruses, and in particular rhinovirus, are the most common causes of exacerbation in children, and some type of respiratory virus has been identified in over 90% of children hospitalized for an episode of wheezing. Changes in the immune response to viral infections in genetically predisposed individuals are very likely to be the main factors involved in the association between viral infection and asthma.
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Affiliation(s)
- M Luz Garcia-Garcia
- Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, Madrid, España.
| | - Cristina Calvo Rey
- Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
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14
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Luz Garcia-Garcia M, Calvo Rey C, del Rosal Rabes T. Pediatric Asthma and Viral Infection. ARCHIVOS DE BRONCONEUMOLOGÍA (ENGLISH EDITION) 2016. [PMID: 26766408 PMCID: PMC7105201 DOI: 10.1016/j.arbr.2016.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Respiratory viral infections, particularly respiratory syncytial virus (RSV) and rhinovirus, are the most importance risk factors for the onset of wheezing in infants and small children. Bronchiolitis is the most common acute respiratory infection in children under 1 year of age, and the most common cause of hospitalization in this age group. RSV accounts for approximately 70% of all these cases, followed by rhinovirus, adenovirus, metapneumovirus and bocavirus. The association between bronchiolitis caused by RSV and the development of recurrent wheezing and/or asthma was first described more than 40 years ago, but it is still unclear whether bronchiolitis causes chronic respiratory symptoms, or if it is a marker for children with a genetic predisposition for developing asthma in the medium or long term. In any case, sufficient evidence is available to corroborate the existence of this association, which is particularly strong when the causative agent of bronchiolitis is rhinovirus. The pathogenic role of respiratory viruses as triggers for exacerbations in asthmatic patients has not been fully characterized. However, it is clear that respiratory viruses, and in particular rhinovirus, are the most common causes of exacerbation in children, and some type of respiratory virus has been identified in over 90% of children hospitalized for an episode of wheezing. Changes in the immune response to viral infections in genetically predisposed individuals are very likely to be the main factors involved in the association between viral infection and asthma.
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15
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de Winter JJH, Bont L, Wilbrink B, van der Ent CK, Smit HA, Houben ML. Rhinovirus wheezing illness in infancy is associated with medically attended third year wheezing in low risk infants: results of a healthy birth cohort study. Immun Inflamm Dis 2015; 3:398-405. [PMID: 26734461 PMCID: PMC4693725 DOI: 10.1002/iid3.77] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/06/2015] [Accepted: 07/08/2015] [Indexed: 01/14/2023] Open
Abstract
Rhinoviruses may be pathogens contributing to the development of childhood wheezing. However, their role in low risk infants without an asthmatic predisposition is unknown. Knowing which healthy, low risk children are at increased risk for childhood wheezing after rhinovirus wheezing illness (RV-WI) in infancy, might help in developing prevention and treatment strategies for childhood wheezing. The aim of this study was to determine the association of medically attended wheezing at the age of three with RV-WI in the first year of life in low risk children without parental asthma. In a low risk, prospective birth cohort study, we followed 181 healthy born children from birth through the third year of life. We considered children 'low risk' if neither parent had a doctor's diagnosis of asthma. We determined infant RV-WI by parent-reported wheezing (based on daily logs) and simultaneous molecular rhinovirus detection in the first year of life. Respiratory function and blood eosinophil count were both measured in the first month of life. The primary outcome, third year wheezing, was defined as the use of prescribed inhaled asthma medications together with a doctor's visit for respiratory symptoms in the third year of life. We calculated the association of RV-WI with medically attended third year wheezing and other known possible risk factors for wheezing at the age of three. Among low risk children, third year wheezing was observed in 7 out of 18 (39%) children with versus 10 out of 163 (6%) children without infant RV-WI (OR 9.7, 95% CI 3.1-33.5, P < 0.0001). The association between RV-WI and third year wheezing was unchanged after adjustment for potential confounders such as eosinophilia and atopic eczema. RV-WI is a robust and independent risk factor for third year wheezing in low risk children without parental asthma. Future research will identify and protect those children at increased risk for RV-WI.
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Affiliation(s)
- Janneke J. H. de Winter
- Department of Pediatrics, University Medical Center UtrechtUtrechtThe Netherlands
- Department of Clinical Immunology and Rheumatology, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Louis Bont
- Department of Pediatrics, University Medical Center UtrechtUtrechtThe Netherlands
| | - Berry Wilbrink
- Laboratory of Infectious Diseases and Perinatal Screening, National Institute of Public Health and the EnvironmentBilthovenThe Netherlands
| | | | - Henriette A. Smit
- Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtUtrechtThe Netherlands
| | - Michiel L. Houben
- Department of Pediatrics, University Medical Center UtrechtUtrechtThe Netherlands
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Green P, Aronoff SC, DelVecchio M. The Effects of Inhaled Steroids on Recurrent Wheeze After Acute Bronchiolitis: A Systematic Review and Meta-Analysis of 748 Patients. Glob Pediatr Health 2015; 2:2333794X15595964. [PMID: 27335972 PMCID: PMC4784589 DOI: 10.1177/2333794x15595964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background. Acute bronchiolitis infection during infancy is associated with an increased risk of asthma later in life. The objective of this study was to determine if inhaled steroids are effective in preventing the development of recurrent wheeze or asthma following acute bronchiolitis. Methods. Multiple databases and bibliographies of selected references were searched. Inclusion required (a) a randomized controlled trial of inhaled steroids and control group, (b) at least 2 weeks duration of therapy started during the acute phase of disease, and (c) identification of the rate of recurrent wheeze or asthma at least 6 months after therapy. Results. Of 1410 studies reviewed, 8 reports were included in this meta-analysis (748 patients). The overall odds ratio for developing recurrent wheeze or asthma with treatment versus without treatment was 1.02 (95% confidence interval = 0.58-1.81). Conclusions. A course of inhaled steroids after acute bronchiolitis is not effective in preventing recurrent wheeze or asthma.
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Affiliation(s)
- Patricia Green
- New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
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17
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Leigh R, Proud D. Virus-induced modulation of lower airway diseases: pathogenesis and pharmacologic approaches to treatment. Pharmacol Ther 2014; 148:185-98. [PMID: 25550230 PMCID: PMC7173263 DOI: 10.1016/j.pharmthera.2014.12.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 12/24/2014] [Indexed: 02/08/2023]
Abstract
Uncomplicated upper respiratory viral infections are the most common cause of days lost from work and school and exert a major economic burden. In susceptible individuals, however, common respiratory viruses, particularly human rhinoviruses, also can have a major impact on diseases that involve the lower airways, including asthma, chronic obstructive pulmonary diseases (COPD) and cystic fibrosis (CF). Respiratory virus-induced wheezing illnesses in early life are a significant risk factor for the subsequent development of asthma, and virus infections may also play a role in the development and progression of airway remodeling in asthma. It is clear that upper respiratory tract virus infections can spread to the lower airway and trigger acute attacks of asthma, COPD or CF. These exacerbations can be life-threatening, and exert an enormous burden on health care systems. In recent years we have gained new insights into the mechanisms by which respiratory viruses may induce acute exacerbations of lower airway diseases, as well as into host defense pathways that may regulate the outcomes to viral infections. In the current article we review the role of viruses in lower airway diseases, including our current understanding on pathways by which they may cause remodeling and trigger acute exacerbations. We also review the efficacy of current and emerging therapies used to treat these lower airway diseases on the outcomes due to viral infection, and discuss alternative therapeutic approaches for the management of virus-induced airway inflammation.
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Affiliation(s)
- Richard Leigh
- Airway Inflammation Research Group, Snyder Institute for Chronic Diseases and Department of Medicine, University of Calgary Faculty of Medicine, Calgary, Canada; Airway Inflammation Research Group, Snyder Institute for Chronic Diseases and Department of Physiology & Pharmacology, University of Calgary Faculty of Medicine, Calgary, Canada
| | - David Proud
- Airway Inflammation Research Group, Snyder Institute for Chronic Diseases and Department of Physiology & Pharmacology, University of Calgary Faculty of Medicine, Calgary, Canada.
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18
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Overeem MMA, Verhagen LM, Hermans PWM, del Nogal B, Sánchez AM, Acevedo NM, Murga RR, Roelfsema J, Pinelli E, de Waard JH. Recurrent wheezing is associated with intestinal protozoan infections in Warao Amerindian children in Venezuela: a cross-sectional survey. BMC Infect Dis 2014; 14:293. [PMID: 24885094 PMCID: PMC4045948 DOI: 10.1186/1471-2334-14-293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 05/14/2014] [Indexed: 12/11/2022] Open
Abstract
Background While in developed countries the prevalence of allergic diseases is rising, inflammatory diseases are relatively uncommon in rural developing areas. High prevalence rates of helminth and protozoan infections are commonly found in children living in rural settings and several studies suggest an inverse association between helminth infections and allergies. No studies investigating the relationship between parasitic infections and atopic diseases in rural children of developing countries under the age of 2 years have been published so far. We performed a cross-sectional survey to investigate the association of helminth and protozoan infections and malnutrition with recurrent wheezing and atopic eczema in Warao Amerindian children in Venezuela. Methods From August to November 2012, 229 children aged 0 to 2 years residing in the Orinoco Delta in Venezuela were enrolled. Data were collected through standardized questionnaires and physical examination, including inspection of the skin and anthropometric measurements. A stool sample was requested from all participants and detection of different parasites was performed using microscopy and real time polymerase chain reaction (PCR). Results We observed high prevalence rates of atopic eczema and recurrent wheezing, respectively 19% and 23%. The prevalence of helminth infections was 26% and the prevalence of protozoan infections was 59%. Atopic eczema and recurrent wheezing were more frequently observed in stunted compared with non-stunted children in multivariable analysis (OR 4.3, 95% CI 1.3 – 13.6, p = 0.015 and OR 4.5, 95% CI 0.97 – 21.2, p = 0.055). Furthermore, recurrent wheezing was significantly more often observed in children with protozoan infections than in children without protozoan infections (OR 6.7, 95% CI 1.5 – 30.5). Conclusions High prevalence rates of atopic eczema and recurrent wheezing in Warao Amerindian children under 2 years of age were related to stunting and intestinal protozoan infections respectively. Helminth infections were not significantly associated with either atopic eczema or recurrent wheezing.
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Affiliation(s)
- Marcella M A Overeem
- Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud University Nijmegen Medical Centre, PO Box 9101 (Internal Post 224), 6500 HB Nijmegen, The Netherlands.
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19
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Inhaled corticosteroids: not able to prevent post-bronchiolitis asthma. Pediatr Infect Dis J 2014; 33:546-7. [PMID: 24732392 DOI: 10.1097/inf.0000000000000255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Hershenson MB. Rhinovirus-Induced Exacerbations of Asthma and COPD. SCIENTIFICA 2013; 2013:405876. [PMID: 24278777 PMCID: PMC3820304 DOI: 10.1155/2013/405876] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/16/2013] [Indexed: 06/01/2023]
Abstract
Over the past two decades, increasing evidence has shown that, in patients with chronic airways disease, viral infection is the most common cause of exacerbation. This review will examine the evidence for viral-induced exacerbations of asthma and chronic obstructive lung disease and the potential mechanisms by which viruses cause exacerbations. Attention will be focused on rhinovirus, the most common cause of respiratory exacerbations. Exacerbations due to rhinovirus, which infects relatively few cells in the airway and does not cause the cytotoxicity of other viruses such as influenza or respiratory syncytial virus, are particularly poorly understood. While the innate immune response likely plays a role in rhinovirus-induced exacerbations, its precise role, either adaptive or maladaptive, is debated. Because current treatment strategies are only partially effective, further research examining the cellular and molecular mechanisms underlying viral-induced exacerbations of chronic airways diseases is warranted.
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Affiliation(s)
- Marc B. Hershenson
- Departments of Pediatrics and Communicable Diseases and Molecular and Integrative Physiology, University of Michigan Medical School, 1150 W. Medical Center Drive, Room 3570B, Medical Science Research Building 2, Ann Arbor, MI 48109-5688, USA
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21
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Ruotsalainen M, Hyvärinen MK, Saari A, Piippo-Savolainen E, Korppi M. No association between overweight and asthma or allergy in adolescence after wheezing in infancy. Acta Paediatr 2013. [PMID: 23190250 DOI: 10.1111/apa.12082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS The aim of the study was to evaluate the association between weight status and asthma, allergy and respiratory symptoms in adolescents with bronchiolitis in infancy. SUBJECTS AND METHODS At age 15-18 years, a questionnaire was sent to 96 study subjects hospitalized for wheezing at age <24 months and followed up subsequently. Sixty-seven (70%) of them answered. Weight and height data for body mass index (BMI) calculation were available in 60 (63%) cases. Asthma, allergy, respiratory symptoms and the use of asthma medication were compared between overweight or obese and normal weight groups constructed by age- and sex-specific BMI standard deviation scores (BMI-SDS). Population controls matched for sex, and birth month and place, were recruited for this study phase at age 15-18 years. RESULTS Eleven (18.3%) study subjects were overweight (BMI-SDS >0.78 in males and >1.16 in females) and only 3 (5.0%) were obese (BMI-SDS >1.70 in males and >2.10 in females) at 16.5 (median) years of age. Overweight or obesity had no significant association with doctor-diagnosed or self-reported asthma, allergy or the use of inhaled corticosteroids. The negative results were confirmed by adjusted analyses. CONCLUSION Weight status had no association with asthma or allergy in adolescence after wheezing in infancy.
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Affiliation(s)
- Marja Ruotsalainen
- Department of Pediatrics; University of Eastern Finland and Kuopio University Hospital; Kuopio; Finland
| | - Mari K Hyvärinen
- Department of Pediatrics; University of Eastern Finland and Kuopio University Hospital; Kuopio; Finland
| | - Antti Saari
- Department of Pediatrics; University of Eastern Finland and Kuopio University Hospital; Kuopio; Finland
| | - Eija Piippo-Savolainen
- Department of Pediatrics; University of Eastern Finland and Kuopio University Hospital; Kuopio; Finland
| | - Matti Korppi
- Pediatric Research Centre; Tampere University and Tampere University Hospital; Tampere; Finland
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22
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Szabo SM, Levy AR, Gooch KL, Bradt P, Wijaya H, Mitchell I. Elevated risk of asthma after hospitalization for respiratory syncytial virus infection in infancy. Paediatr Respir Rev 2013; 13 Suppl 2:S9-15. [PMID: 23269182 DOI: 10.1016/s1526-0542(12)70161-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Severe respiratory syncytial virus (RSV) infection in infancy is associated with substantial morbidity worldwide; whether it is a risk factor for childhood asthma is contentious. A systematic review of 28 articles was conducted, summarizing estimates of asthma risk after RSV hospitalization during infancy. Prevalence estimates of asthma, among those hospitalized for RSV in infancy, were from 8% to 63%, 10% to 92%, and 37%, at ages <5, 5 to 11, and ≥ 12 years, respectively. These rates were higher than those among non-hospitalized comparisons. The attributable risk of asthma due to RSV ranged from 13% to 22% and from 11% to 27% among children aged ≤ 5 and aged 5 to 11, respectively, and was 32% among children ≥ 12 years of age. Overall, 59% of asthma prevalence estimates from those previously hospitalized for RSV exceeded 20%, compared to only 6% of non-hospitalized comparison estimates. Despite variability in asthma prevalence estimates after RSV-related hospitalization, available data suggest a link between severe RSV infection in infancy and childhood asthma.
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Schneider D, Hong JY, Popova AP, Bowman ER, Linn MJ, McLean AM, Zhao Y, Sonstein J, Bentley JK, Weinberg JB, Lukacs NW, Curtis JL, Sajjan US, Hershenson MB. Neonatal rhinovirus infection induces mucous metaplasia and airways hyperresponsiveness. THE JOURNAL OF IMMUNOLOGY 2012; 188:2894-904. [PMID: 22331068 DOI: 10.4049/jimmunol.1101391] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Recent studies link early rhinovirus (RV) infections to later asthma development. We hypothesized that neonatal RV infection leads to an IL-13-driven asthma-like phenotype in mice. BALB/c mice were inoculated with RV1B or sham on day 7 of life. Viral RNA persisted in the neonatal lung up to 7 d postinfection. Within this time frame, IFN-α, -β, and -γ peaked 1 d postinfection, whereas IFN-λ levels persisted. Next, we examined mice on day 35 of life, 28 d after initial infection. Compared with sham-treated controls, virus-inoculated mice demonstrated airways hyperresponsiveness. Lungs from RV-infected mice showed increases in several immune cell populations, as well as the percentages of CD4-positive T cells expressing IFN-γ and of NKp46/CD335(+), TCR-β(+) cells expressing IL-13. Periodic acid-Schiff and immunohistochemical staining revealed mucous cell metaplasia and muc5AC expression in RV1B- but not sham-inoculated lungs. Mucous metaplasia was accompanied by induction of gob-5, MUC5AC, MUC5B, and IL-13 mRNA. By comparison, adult mice infected with RV1B showed no change in IL-13 expression, mucus production, or airways responsiveness 28 d postinfection. Intraperitoneal administration of anti-IL-13 neutralizing Ab attenuated RV-induced mucous metaplasia and methacholine responses, and IL-4R null mice failed to show RV-induced mucous metaplasia. Finally, neonatal RV increased the inflammatory response to subsequent allergic sensitization and challenge. We conclude that neonatal RV1B infection leads to persistent airways inflammation, mucous metaplasia, and hyperresponsiveness, which are mediated, at least in part, by IL-13.
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Affiliation(s)
- Dina Schneider
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI 48109-5688, USA
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Piovano E, Pivetta E, Modaffari P, Martra F, Baima Poma C, Perotto S, Tripodi E, Zanfagnin V, Zola P, Ferrero A. A Search for Predictive Factors for Hypersensitivity Reactions to Paclitaxel and Platinum Salts in Chemotherapy for Gynecologic Pelvic Neoplasms. Gynecol Obstet Invest 2012; 74:21-7. [DOI: 10.1159/000336772] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 01/24/2012] [Indexed: 11/19/2022]
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Sidoroff V, Hyvärinen MK, Piippo-Savolainen E, Korppi M. Overweight does not increase asthma risk but may decrease allergy risk at school age after infantile bronchiolitis. Acta Paediatr 2012; 101:43-7. [PMID: 21824194 DOI: 10.1111/j.1651-2227.2011.02439.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
AIM Increasing evidence suggests that overweight children are at increased risk of asthma. The association between weight gain and allergy is more complex. The aim was to evaluate the association between overweight or obesity and asthma, allergy, bronchial reactivity or atopic sensitization at school age in children with bronchiolitis in infancy. SUBJECTS AND METHODS Eighty-one children hospitalized for bronchiolitis at <24 months of age attended control visits at 7.2 and 12.3 years of ages. The visits consisted of medical examinations, weight and height measurements, body mass index (BMI) calculations, skin prick tests and exercise challenge tests. BMI >1.3 SD from age- and gender-specific references meant overweight and BMI >2.0 SD obesity. RESULTS Current or previous overweight or obesity did not increase the risk of asthma, allergy, bronchial reactivity or atopic sensitization at 7.2 or 12.3 years of age. Previous and current obesity decreased the risk of atopic dermatitis, and current overweight and obesity decreased the risk of sensitization to outdoor allergens at 12.3 years of age. CONCLUSION Previous or current overweight does not increase asthma or allergy risk but current obesity may decrease allergy risk at school age after bronchiolitis in infancy.
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Affiliation(s)
- Virpi Sidoroff
- Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
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Koster ES, Van der Ent CK, Uiterwaal CSPM, Verheij TJM, Raaijmakers JAM, Maitland-van der Zee AH. Asthma medication use in infancy: determinants related to prescription of drug therapy. Fam Pract 2011; 28:377-84. [PMID: 21292627 DOI: 10.1093/fampra/cmr002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about factors that determine prescribing of asthma therapy in infancy. OBJECTIVE To describe factors related to the initiation and refill of asthma therapy in infancy. METHODS This study included 1202 infants who participated in a prospective birth cohort study: the 'Wheezing Illnesses Study Leidsche Rijn (WHISTLER)'. Outcomes, asthma therapy initiation and refill, were assessed using prescription data. Logistic regression analysis was used to study determinants of therapy initiation in two groups: total population and infants with a respiratory system symptom diagnosis. In addition, determinants of refilling prescriptions were studied in infants who started therapy in their first year of life. RESULTS Fifteen per cent of all infants started asthma therapy in their first year of life. Respiratory symptoms were an important driver of both initiation and refill of prescriptions. In the total population, therapy initiation was associated with male gender [odds ratio (OR): 1.6, 95% confidence interval (CI): 1.1-2.6], day-care attendance (OR: 1.6, 95% CI: 1.0-2.5) and breastfeeding (OR: 0.6, 95% CI: 0.3-1.0). For infants with a respiratory system symptom diagnosis, day-care attendance was associated with an increased chance of therapy initiation (OR: 5.3, 95% CI: 1.8-16.2) and breastfeeding was associated with a lower chance of starting therapy (OR: 0.4, 95% CI: 0.1-1.1). Dutch children had a higher chance of refilling prescriptions in infancy (OR: 5.3, 95% CI: 1.1-26.8). CONCLUSIONS Apart from other factors involved, the principal reason for initiation and refill of asthma therapy in infancy was the presence of respiratory symptoms. This appeared the only reason to prescribe medication and physicians are not distracted by other factors.
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Affiliation(s)
- Ellen S Koster
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht
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Brouard J, Vabret A, Freymuth F. [Properly assessing respiratory syncytial virus epidemic]. Arch Pediatr 2011; 13 Suppl 5:S1-7. [PMID: 17550818 PMCID: PMC7133487 DOI: 10.1016/s0929-693x(06)80009-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jacques Brouard
- Service de Pédiatrie, CHRU de Caen, avenue Clémenceau, 14033 Caen, France.
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Sidoroff V, Hyvärinen M, Piippo-Savolainen E, Korppi M. Lung function and overweight in school aged children after early childhood wheezing. Pediatr Pulmonol 2011; 46:435-41. [PMID: 21194138 DOI: 10.1002/ppul.21386] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 11/01/2010] [Accepted: 11/04/2010] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Recently, obesity has been connected with wheezing, asthma and reduced lung function. Most previous studies have been cross-sectional. The aim of the present follow-up study was to evaluate the association of preceding or current overweight or obesity with lung function at early and late school age after early childhood wheezing. MATERIAL AND METHODS From the 100 children hospitalized for infection associated wheezing at <24 months of age, 83 attended the control visit at 4.0 years, 82 at 7.2 years and 81 at 12.3 years of age. Flow-volume spirometry was performed in 79 children at 7.2 years and in 80 children at 12.3 years of age. The weight status was assessed by calculating body mass index (BMI) at all visits. Age- and gender-specific BMI standard deviation scores (BMI-SDS) of >1.3 SD and >2.0 SD were defined to mean overweight and obesity, respectively. RESULTS Overweight at both 7.2 and 12.3 years of age was associated with decreased FEV1 /FVC (forced expiratory volume in 1 sec/forced vital capacity). Overweight and obesity at 7.2 years of age were associated with decreased FEV1 /FVC and MEF50 (maximal expiratory flow at 50% of FVC) at 12.3 years of age. The results were similar by continuous and categorized analyses, being robust to adjustments for viral findings during early childhood wheezing and asthma maintenance medication at school age. CONCLUSION Overweight and obesity are significant risk factors for reduced lung function at school age after early childhood wheezing. Thus, early-life wheezers should avoid excessive weight gain during childhood.
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Affiliation(s)
- Virpi Sidoroff
- Department of Pediatrics, School of Medicine, University of Eastern Finland, Kuopio, Finland.
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Dulek DE, Peebles RS. Viruses and asthma. Biochim Biophys Acta Gen Subj 2011; 1810:1080-90. [PMID: 21291960 PMCID: PMC3130828 DOI: 10.1016/j.bbagen.2011.01.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 01/21/2011] [Accepted: 01/21/2011] [Indexed: 01/19/2023]
Abstract
Background Viral respiratory infection has long been known to influence the occurrence of asthma exacerbations. Over the last 20 years much effort has been put into clarifying the role that viral respiratory infections play in the eventual development of asthma. Scope of review In this review we give a general background of the role of viruses in the processes of asthma exacerbation and asthma induction. We review recent additions to the literature in the last 3 years with particular focus on clinical and epidemiologic investigations of influenza, rhinovirus, bocavirus, respiratory syncytial virus, and metapneumovirus. Major conclusions The development of asthma emerges from a complex interaction of genetic predisposition and environmental factors with viral infection likely playing a significant role in the effect of environment on asthma inception. This article is part of a Special Issue entitled: Biochemistry of Asthma. General significance Further understanding of the role that viruses play in asthma exacerbation and inception will contribute to decreased asthma morbidity in the future. This article is part of a Special Issue entitled: Biochemistry of Asthma.
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Affiliation(s)
- Daniel E Dulek
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN 37232-2650, USA.
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Puig C, Fríguls B, Gómez M, García-Algar O, Sunyer J, Vall O. [Relationship between lower respiratory tract infections in the first year of life and the development of asthma and wheezing in children]. Arch Bronconeumol 2010; 46:514-21. [PMID: 20832927 DOI: 10.1016/j.arbres.2010.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 05/27/2010] [Accepted: 07/02/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION There is limited knowledge on the relationship between lower respiratory tract infections (LRTI) and asthma and wheezing during infancy, as there are few studies with prospective design, birth cohort and in non selected population. The objectives of the present study were to determine the prevalence of asthma and recurrent wheezing in childhood and to analyse the relationship between LTRI during the first year of life and the development of asthma and/or wheezing in childhood. PATIENTS AND METHODS Prospective birth cohort study conducted in the Hospital del Mar (Barcelona). We recruited 487 children, followed up from the pregnancy to the 6th year of life. As outcomes we studied: the presence of asthma and wheezing. As independent variables we studied: LTRI occurring during the first year of life, and some covariables including, among others: prematurity, birth weight, maternal history of asthma and atopy, breastfeeding, prenatal exposure to tobacco. RESULTS The asthma prevalence at 6 year of age was 9.3%. The variables associated with the development of asthma were LTRI, prematurity, atopic mother and formula breastfeeding. LTRI during the first year of life were also related with early recurrent wheezing and persistent wheezing. CONCLUSIONS Our results confirm that LTRI during the first year of life are related to the diagnosis of asthma and with the clinical phenotypes of early wheezing and persistent wheezing. These results are in accordance with the concept that LTRI occurring during a critical period of development, as are the first years of life, have an important role on in the later development of asthma and recurrent wheezing.
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Affiliation(s)
- Carme Puig
- IMIM-Hospital del Mar, Barcelona, España
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Ochoa Sangrador C, González de Dios J. [Consensus conference on acute bronchiolitis (VI): prognosis of acute bronchiolitis. Review of scientific evidence]. An Pediatr (Barc) 2010; 72:354.e1-354.e34. [PMID: 20409766 DOI: 10.1016/j.anpedi.2009.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Accepted: 12/21/2009] [Indexed: 02/06/2023] Open
Abstract
We present a review of the evidence on prognosis of acute bronchiolitis, risk factors for severe forms, symptom or severity scores and risk of post-bronchiolitis asthma. Documented risk factors of long stay or PICU admission in hospitalized patients are: bronchopulmonary dysplasia and/or chronic lung disease, prematurity, congenital heart disease and age less than 3 months. Other less well documented risk factors are: tobacco exposure, history of neonatal mechanical ventilation, breastfeeding for less than 4 months, viral co-infection and other chronic diseases. There are several markers of severity: toxic appearance, tachypnea, hypoxia, atelectasis or infiltrate on chest radiograph, increased breathing effort, signs of dehydration, tachycardia and fever. Although we have some predictive models of severity, none has shown sufficient predictive validity to recommend its use in clinical practice. While there are different symptom or severity scores, none has proven to be valid or accurate enough to recommend their preferable application in clinical practice. There seems to be a consistent and strong association between admission due to bronchiolitis and recurrent episodes of wheezing in the first five years of life. However it is unclear whether this association continues in subsequent years, as there are discordant data on the association between bronchiolitis and asthma.
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Affiliation(s)
- C Ochoa Sangrador
- Servicio de Pediatría, Hospital Virgen de la Concha, Zamora, España.
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32
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Hyvärinen MK, Kotaniemi-Syrjänen A, Reijonen TM, Piippo-Savolainen E, Kiviniemi V, Korppi M. Serum myeloperoxidase in wheezing infants: no association with later asthma. Pediatr Pulmonol 2010; 45:406-8. [PMID: 20146369 DOI: 10.1002/ppul.21140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
The prevalence of human allergy to pet danders has increased rapidly over the past six decades, as a consequence of lifestyle changes that have enhanced ambient exposure to pet allergens. This is a problem of global public health importance, as the morbidity associated with allergic diseases disproportionately affects socio-economically disadvantaged populations, particularly children. Although the public often seeks advice from veterinary health-care professionals regarding healthy pet ownership practices, including strategies for reducing residential pet dander exposure, many misconceptions persist in the public domain regarding pet dander allergy, such as the belief that certain dog and cat breeds are 'hypoallergenic' due to their hair/coat type. This review considers the epidemiology of human exposure to the major cat and dog dander allergens, Fel d 1 and Can f 1 respectively, and the sensitization mechanisms to them, including the hygiene hypothesis and the putative role of bacterial endotoxin. The literature regarding primary and secondary exposures in different ambient environments is explored including threshold effects that influence allergen sensitization and elicitation of symptoms, and environmental intervention strategies that seek to reduce allergen exposure. Pet-specific factors, including the aetiopathogenesis of the several cat and dog allergens that have been characterized to the molecular level, individual animal characteristics that influence Fel d 1 and Can f 1 shedding, and pet-directed interventions intended to reduce allergen dispersal, are discussed.
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Affiliation(s)
- Daniel O Morris
- Department of Clinical Studies - Philadelphia, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey St., Philadelphia, PA 19104, USA.
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Mansbach JM, Camargo CA. Respiratory viruses in bronchiolitis and their link to recurrent wheezing and asthma. Clin Lab Med 2010; 29:741-55. [PMID: 19892232 PMCID: PMC2810250 DOI: 10.1016/j.cll.2009.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jonathan M Mansbach
- Department of Medicine, Children's Hospital Boston, Harvard Medical School, Main Clinical Building 9 South, #9157, Boston, MA 02115, USA.
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Hyvärinen MK, Kotaniemi-Syrjänen A, Reijonen TM, Piippo-Savolainen E, Korppi M. Eosinophil activity in infants hospitalized for wheezing and risk of persistent childhood asthma. Pediatr Allergy Immunol 2010; 21:96-103. [PMID: 19793065 DOI: 10.1111/j.1399-3038.2009.00873.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Eosinophilic inflammation has a central role in the pathogenesis of asthma. We aimed to elucidate whether elevated blood eosinophil count (B-EOS), eosinophil cationic protein in serum (S-ECP) or in nasopharyngeal aspirate (NPA-ECP) predict later asthma after hospitalization for wheezing in infancy. In 1992-1993, 100 infants aged <24 months were hospitalized for wheezing associated with respiratory infection. B-EOS, S-ECP and NPA-ECP were measured on admission. Asthma status was evaluated at the follow-up visits at the median ages of 4.0, 7.2 and 12.3 yr. Twenty (25%) of 81 children had asthma at all three visits and were considered to have persistent childhood asthma (PCA). Children with B-EOS >or= 0.450 x 10(9) cells/l had a 2.9-fold PCA risk compared with other children. The risk was 6.1-fold when S-ECP was >or=20.0 microg/l and 6.7-fold when NPA-ECP was >or=815.0 ng/g. By these cut-off limits, all these markers were specific (75-93%), but not very sensitive (30-58%) in predicting PCA. At least one marker was elevated in 75% of the children with PCA. The respective figure for NPA-ECP alone was 58%. In adjusted analyses, only elevated NPA-ECP was an independent risk factor for PCA (OR 4.09). In conclusion, eosinophil activity in early life predicts the development of childhood asthma after hospitalization for wheezing in infancy. The results highlight NPA-ECP as an independent predictor of the persistence of asthma at school age.
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Affiliation(s)
- Mari K Hyvärinen
- Department of Pediatrics, Kuopio University and Kuopio University Hospital, Kuopio, Finland.
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Affiliation(s)
- Woo Kyung Kim
- Department of Pediatrics, Inje University, College of Medicine, Seoul, Korea
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37
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Abstract
PURPOSE OF REVIEW Virus-induced wheezing in infancy is a risk factor for asthma, and recent studies have highlighted the role of rhinoviruses in causing acute illnesses and as a possible contributing factor to chronic asthma. RECENT FINDINGS Human rhinoviruses (HRVs) have long been known as the most common cause of common cold in infants and children. Recent developments in molecular diagnostics have led to the discovery of new viruses and have also provided data to implicate HRV as an important cause of lower respiratory infections and acute virus-induced wheezing in preschool children. In addition, HRV-induced wheezing episodes appear to identify children who are at increased risk for the subsequent development of childhood asthma. SUMMARY Collectively, these findings raise the possibility that lower respiratory infections with pathogens such as HRV and respiratory syncytial virus could participate in the causation of asthma, especially in children with suboptimal antiviral defenses. A variety of experimental models and clinical studies have been used to identify possible mechanisms related to the infection and the ensuing host response that could disturb normal lung and immunologic development to promote asthma. Defining these relationships could lead to new therapeutic and preventive approaches to common forms of childhood asthma.
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Valkonen H, Waris M, Ruohola A, Ruuskanen O, Heikkinen T. Recurrent wheezing after respiratory syncytial virus or non-respiratory syncytial virus bronchiolitis in infancy: a 3-year follow-up. Allergy 2009; 64:1359-65. [PMID: 19416146 DOI: 10.1111/j.1398-9995.2009.02022.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Recent studies have suggested that rhinovirus-associated early wheezing is a greater risk factor for development of recurrent wheezing in children than is early wheezing associated with respiratory syncytial virus (RSV). We determined the development of recurrent wheezing in young children within 3 years after hospitalization for RSV or non-RSV bronchiolitis. METHODS We identified retrospectively all children <2 years of age who were admitted to Turku University Hospital because of bronchiolitis in the months of August-December during 1988-2001. The primary outcome was recurrent wheezing that required long-term asthma medication. Data on asthma medications of the individual children were derived from the Social Insurance Institution of Finland. RESULTS Within the first year after hospitalization, 36 of 217 (16.6%) children with non-RSV bronchiolitis developed recurrent wheezing, compared with five of 199 (2.5%) children with RSV bronchiolitis [relative risk (RR) 6.6; 95% confidence interval (CI) 2.6-16.5]. The rates of recurrent wheezing were significantly increased in the non-RSV group also within 2 years (RR 2.9; 95% CI 1.7-5.1) and 3 years (RR 3.4; 95% CI 2.0-5.7) after hospitalization. The increased risk of recurrent wheezing in children with non-RSV-associated bronchiolitis was observed both in boys and girls at all time points of the 3-year follow-up, and it was not explained by the age difference between the RSV and non-RSV groups or any confounding seasonal factors. CONCLUSION Children hospitalized with bronchiolitis caused by other viruses than RSV develop recurrent wheezing at substantially higher rates during a 3-year follow-up period than do children with RSV-induced bronchiolitis.
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Affiliation(s)
- H Valkonen
- Department of Pediatrics, Turku University Hospital, Finland
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39
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Hyvärinen M, Sidorof V, Korppi M. Overweight: no association with asthma or bronchial reactivity in children. J Allergy Clin Immunol 2009; 124:1119; author reply 119-20. [PMID: 19703705 DOI: 10.1016/j.jaci.2009.06.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Accepted: 06/25/2009] [Indexed: 10/20/2022]
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40
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Legru E, Lees O, Bubenheim M, Boyer O, Marguet C. [Biological markers in acute bronchiolitis: Correlations with gravity and risk factors for asthma]. ACTA ACUST UNITED AC 2009; 22:171-181. [PMID: 32288392 PMCID: PMC7146813 DOI: 10.1016/j.jpp.2009.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
La bronchiolite aiguë est une infection virale respiratoire épidémique du nourrisson. Le virus respiratoire syncytial est l’agent infectieux le plus fréquent au cours des bronchiolites. D’autres virus sont retrouvés, seuls ou en co-infections virales. Ce travail est une étude dont le but est de rechercher un ou des marqueurs biologiques prédictifs de la gravité d’un épisode de bronchiolite aiguë et de l’évolution vers un asthme du nourrisson, dans le cadre du protocole Bronchiolite (PHRC 2000 no 2000/020/HP), étude de cohorte, prospective, multicentrique, réalisée de novembre 2001 à janvier 2006. Sept centres ont participé : Rouen, Le Havre, Lille, Elbeuf, Evreux, Brest et Saint-Nazaire en association avec Nantes. Les données clinicobiologiques étaient recueillies au cours de l’hospitalisation initiale, puis lors des visites suivantes à un mois et à un an. Ainsi, 209 nourrissons âgés en moyenne de trois mois ont été suivis avec une évaluation de la gravité sur des critères cliniques. Les résultats de laboratoires ont été corrélés aux éléments de gravité pour les résultats suivants : identification virale, numération des leucocytes, lymphocytes et éosinophiles, étude en cytométrie en flux de populations lymphocytaires et allergologie incluant les IgE, l’eosinophilic cationic protein et test d’activation des basophiles. Les résultats de cette étude sont présentés et discutés.
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Affiliation(s)
- E Legru
- Service de pédiatrie médicale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - O Lees
- Laboratoire d'immunopathologie clinique et expérimentale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - M Bubenheim
- Unité de biostatistiques, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - O Boyer
- Laboratoire d'immunopathologie clinique et expérimentale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - C Marguet
- Service de pédiatrie médicale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
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Mansbach JM, Espinola JA, Macias CG, Ruhlen ME, Sullivan AF, Camargo CA. Variability in the diagnostic labeling of nonbacterial lower respiratory tract infections: a multicenter study of children who presented to the emergency department. Pediatrics 2009; 123:e573-81. [PMID: 19273503 DOI: 10.1542/peds.2008-1675] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The diagnostic labeling of presumed nonbacterial lower respiratory tract infection is unclear. Our objective was to identify patterns of specific diagnoses and treatments that were given to children who presented with lower respiratory tract infection to US academic emergency departments. METHODS Data were collected on all children who were aged <2 years and had lower respiratory tract infection symptoms during a similar 2- to 3-week winter period at 4 pairs of emergency departments from the same state or region. The children were identified by using relevant International Classification of Diseases, Ninth Revision, Clinical Modification codes in the primary diagnosis field. Data were collected by using standardized chart review forms for the index emergency department visit and also for 1 month before through 1 year after the index visit. RESULTS Among the 928 children who presented with lower respiratory tract infection symptoms, 676 (73%) were younger than 12 months and 624 (67%) had a primary diagnosis of bronchiolitis. When comparing the assigned diagnoses between emergency department pairs, bronchiolitis was the more common diagnosis at certain hospitals, whereas asthma, cough, and wheeze were more frequent at others. Independent predictors of corticosteroid treatment were visiting specific emergency departments, older age, an asthma diagnosis (compared with bronchiolitis), documented history of wheezing, observed wheezing during the index visit, eosinophil values >4%, previous use of corticosteroids, and parental history of asthma. CONCLUSIONS For children who are age <2 years and present to an emergency department with lower respiratory tract infection symptoms, there is large variability in the assigned diagnosis. Children who present to emergency departments that more commonly diagnose lower respiratory tract infection as "asthma" are more likely to receive corticosteroids. As clinicians, we need to develop evidence- and outcome-based definitions for lower respiratory tract infections to guide diagnosis and treatment better.
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Affiliation(s)
- Jonathan M Mansbach
- Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Legru E, Lees O, Bubenheim M, Boyer O, Marguet C. [Biological markers in acute bronchiolitis: correlations with gravity and risk factors for asthma]. ACTA ACUST UNITED AC 2009; 2009:61-70. [PMID: 32518600 PMCID: PMC7270340 DOI: 10.1016/s1773-035x(09)71683-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 12/19/2008] [Indexed: 11/16/2022]
Abstract
La bronchiolite aiguë est une infection virale respiratoire épidémique du nourrisson. Le virus respiratoire syncytial est l’agent infectieux le plus fréquent au cours des bronchiolites. D’autres virus sont retrouvés, seuls ou en co-infections virales. Ce travail est une étude dont le but est de rechercher un ou des marqueurs biologiques prédictifs de la gravité d’un épisode de bronchiolite aiguë et de l’évolution vers un asthme du nourrisson, dans le cadre du protocole Bronchiolite (PHRC 2000 n° 2000/020/HP), étude de cohorte, prospective, multicentrique, réalisée de novembre 2001 à janvier 2006. Sept centres ont participé : Rouen, Le Havre, Lille, Elbeuf, Évreux, Brest et Saint-Nazaire en association avec Nantes. Les données clinico-biologiques étaient recueillies au cours de l’hospitalisation initiale, puis lors des visites suivantes à un mois et à un an. Ainsi 209 nourrissons âgés en moyenne de 3 mois ont été suivis avec une évaluation de la gravité sur des critères cliniques. Les résultats de laboratoires ont été corrélés aux éléments de gravité pour les résultats suivants : identification virale, numération des leucocytes, lymphocytes et éosinophiles, étude en cytométrie en flux de populations lymphocytaires et allergologie incluant les IgE, l’eosinophil cationic protein et test d’activation des basophiles. Les résultats de cette étude sont présentés et discutés.
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Affiliation(s)
- Emilie Legru
- Service de pédiatrie médicale, Centre hospitalier universitaire Charles Nicolle, 1, rue de Germont, 76031 Rouen cedex
| | - Olivier Lees
- Laboratoire d’immunopathologie clinique et expérimentale, Centre hospitalier universitaire Charles Nicolle, 1, rue de Germont, 76031 Rouen cedex
- Correspondance.
| | - Michael Bubenheim
- Unité de biostatistiques, Centre hospitalier universitaire Charles Nicolle, 1, rue de Germont, 76031 Rouen cedex
| | - Olivier Boyer
- Laboratoire d’immunopathologie clinique et expérimentale, Centre hospitalier universitaire Charles Nicolle, 1, rue de Germont, 76031 Rouen cedex
| | - Christophe Marguet
- Service de pédiatrie médicale, Centre hospitalier universitaire Charles Nicolle, 1, rue de Germont, 76031 Rouen cedex
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Korppi M, Hyvärinen M, Kotaniemi-Syrjänen A, Piippo-Savolainen E, Reijonen T. Early exposure and sensitization to cat and dog: different effects on asthma risk after wheezing in infancy. Pediatr Allergy Immunol 2008; 19:696-701. [PMID: 19076565 DOI: 10.1111/j.1399-3038.2008.00758.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Birth cohort studies have suggested that early exposure to furred pets protects from later asthma and allergy. The aim of the present study was to evaluate the association between exposure or sensitization to cat or dog in infancy, and later asthma and allergy assessed at the median ages of 4.0, 7.2 and 12.3 yr, in children who have wheezed at <24 months of age. Exposure to cat and dog in infancy was assessed by interviewing the parents. The child was considered as sensitized, if the allergen-specific IgE to cat or to dog was >or=0.35 kU/l, or if there was a positive skin test response. When the 20 children with persistent childhood asthma (doctor-diagnosed asthma at all three control visits) were compared with the other 61 children, an early exposure to dog (OR = 0.14, p = 0.034)) decreased the asthma risk and an early sensitization to cat (OR = 5.92, p = 0.008) and dog (OR = 9.33, p = 0.001) increased the asthma risk. There were less cat and dog keeping in atopic families and the effect of sensitization was, but the effect of exposure was not, robust to adjustments in multivariate analyses. The present study demonstrates, in a long-term follow-up after early wheezing, that early sensitization to cat and dog increases the risk of later asthma but early exposure to cat or dog has no such effect. Dog keeping was less frequent in atopic families, which may explain that the protective effect of early exposure to dog was lost in multivariate analyses.
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Affiliation(s)
- Matti Korppi
- Pediatric Research Center, Tampere University and University Hospital, Tampere, Finland.
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Yasuno T, Shimizu T, Maeda Y, Yamasaki A, Amaya E, Kawakatsu H. Wheezing illness caused by respiratory syncytial virus and other agents. Pediatr Int 2008; 50:500-5. [PMID: 18937754 DOI: 10.1111/j.1442-200x.2008.02702.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) and other pathogenic agents cause lower respiratory infection with wheezing in infants (wheezing illness in infancy). Wheezing illness in infancy due to RSV can be life-threatening and can induce recurrent wheezing; but these events can also be produced by infection by other pathogenic agents. Thus, whether RSV induces more severe wheezing illness in infancy remains poorly understood. METHODS Infants with an initial wheezing illness were divided into an RSV-positive group and an RSV-negative group and the differences in disease severity, intensity of acute symptoms, and susceptibility to recurrent wheezing, between these two groups, were investigated. RESULTS The RSV-positive group accounted for 57.4% of the infants. The infants in the RSV-positive group were significantly younger than those in the RSV-negative group. Other background parameters, gender and family history, were not significantly different. There were no significant differences in indicators of severity (hospitalization periods, periods of persistent wheezing and requirement of oxygen supplementation) between the two groups. CONCLUSION Wheezing illness in infancy caused by RSV is more common in younger infants, but it is not more severe than that caused by other pathogenic agents.
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Affiliation(s)
- Tetsuya Yasuno
- Department of Pediatrics, Kyoto City Hospital, Kyoto, Japan.
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Carroll KN, Hartert TV. The impact of respiratory viral infection on wheezing illnesses and asthma exacerbations. Immunol Allergy Clin North Am 2008; 28:539-61, viii. [PMID: 18572106 PMCID: PMC2504766 DOI: 10.1016/j.iac.2008.03.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The etiology and morbidity associated with asthma are thought to stem from both genetic factors and potentially modifiable environmental factors, such as viral infections. Although it is unclear whether respiratory viral infections cause asthma, observational studies have demonstrated a high rate of asthma in children with a history of severe viral lower respiratory tract infections during infancy, and viruses are associated with the majority of asthma exacerbations among both children and adults. This article discusses the pathogens associated with virus-induced wheezing illnesses during infancy and early childhood, the association of bronchiolitis during infancy with an increased risk of childhood asthma, and the association of respiratory viruses with asthma exacerbations in older children and adults.
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Affiliation(s)
- Kecia N Carroll
- Department of Pediatrics, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-2504, USA
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Piippo-Savolainen E, Korppi M. Wheezy babies--wheezy adults? Review on long-term outcome until adulthood after early childhood wheezing. Acta Paediatr 2008; 97:5-11. [PMID: 18052998 DOI: 10.1111/j.1651-2227.2007.00558.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
UNLABELLED Population-based birth cohort studies have documented that about 30% of children suffer from wheezing during respiratory infection before their third birthday. Recurrent wheezing is common in early childhood, but most patients outgrow their symptoms by school age. However, recent long-term postbronchiolitis follow-up studies from Sweden and Finland have revealed that asthma is present in about 40% of young adults and over half of the cases are relapses after many symptom-free years. In population studies, the principal predictors for later asthma have been parental asthma, recurrent wheezing, atopy and eosinophilia. In the Swedish postbronchiolitis study, atopic diathesis through the development of clinical atopy, and early passive smoking through bronchial hyper-reactivity or later active smoking led to adult asthma. The Finnish postbronchiolitis follow-up stressed early recurrence of wheezing, wheezing induced by less invasive viruses than respiratory syncytial virus (RSV), early-life atopy and eosinophilia and parental asthma as predictors for adult asthma. CONCLUSION The majority of wheezing infants and children outgrow their symptoms by school age, but based on recent long-term follow-up studies, asthma relapses are common in young adults. These studies have highlighted parental asthma, maternal smoking and wheezing induced by other viruses than RSV as predictive factors for later asthma.
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Affiliation(s)
- Eija Piippo-Savolainen
- Department of Paediatrics, Kuopio University and University Hospital, FIN-70210 Kuopio, Finland.
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Abstract
OBJECTIVES To analyze the clinical features and estimate the hospitalization disease burden of rhinovirus infection in children in Hong Kong. METHODS In this prospective study, nasopharyngeal aspirates were taken from children aged <18 years with symptoms of acute respiratory infection admitted to Queen Mary Hospital on one fixed day of the week during August 2001-July 2002 for detection of common respiratory viruses by immunofluorescence, viral culture, and for rhinovirus, human metapneumovirus, and coronaviruses by reverse transcription polymerase chain reaction. The clinical features of rhinovirus infections were analyzed and hospitalization disease burden was estimated. RESULTS Altogether 239 of the 426 nasopharyngeal aspirates (56.1%) were positive for respiratory viruses, including 151 patients with rhinovirus (35.4%). The median age was 2.34 years. Upper respiratory infection, asthma exacerbation, pneumonia, and acute bronchiolitis were diagnosed in 44.4%, 19.9%, 11.3%, and 7.9%, respectively. The most common symptoms were cough (81.5%), runny nose (76.8%), and fever (68.9%). Shortness of breath, wheezes, and crepitation were present in 25.8%, 29.1%, and 18.5%, respectively. Fifty-five of 99 patients (55.6%) had chest radiographic abnormalities, most commonly perihilar streakiness. Children with chronic diseases were more likely to have lower respiratory tract infection and these children required longer hospitalization (mean 0.6 days longer). Coinfection with other respiratory pathogens was common (33.1%). CONCLUSION Rhinovirus is frequently associated with asthmatic exacerbations and lower respiratory tract infection, especially in children with chronic diseases and is potentially an important contributor to hospitalization in children in Hong Kong.
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Wallaert B, Kouzan S, Leroyer C, Delacourt C, Roguedas AB. Quelle est la place de l’examen clinique chez l’asthmatique allergique ? Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)73300-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hyvärinen MK, Kotaniemi-Syrjänen A, Reijonen TM, Korhonen K, Korppi MO. Lung function and bronchial hyper-responsiveness 11 years after hospitalization for bronchiolitis. Acta Paediatr 2007; 96:1464-9. [PMID: 17880415 PMCID: PMC7159626 DOI: 10.1111/j.1651-2227.2007.00458.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aim: Atopic infants hospitalized for wheezing not caused by respiratory syncytial virus (RSV) carry the highest risk for later asthma. In the present paper, early risk factors for later lung function abnormalities and for bronchial hyper‐responsiveness (BHR) were evaluated in 81 children, hospitalized for bronchiolitis in infancy, at the median age of 12.3 years. Methods: The basic data, including data on atopy in children and viral aetiology of bronchiolitis, had been collected on entry to the study at less than 2 years of age. Lung function was studied by flow‐volume spirometry (FVS), and BHR by methacholine and exercise challenge tests 11.4 years after hospitalization during infancy. Results: RSV aetiology of bronchiolitis was associated with reduced forced vital capacity (FVC; 93.65% of predicted ± 11.05 vs. 99.57%± 12.59, p = 0.009). Early sensitization to inhalant allergens (OR 12.59, 95% CI 2.30–68.77) and maternal smoking during pregnancy (OR 4.58, 95% CI 1.28–16.39) were associated with BHR to exercise, and early atopic dermatitis (OR 3.48, 95% CI 1.09–11.10) was associated with BHR to methacholine. Conclusions: RSV bronchiolitis was associated with a restrictive pattern of lung function. Early atopy and maternal smoking during pregnancy may play a role in the development and persistence of BHR.
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Affiliation(s)
- M K Hyvärinen
- Department of Paediatrics, Kuopio University and Kuopio University Hospital, Kuopio, Finland.
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Pérez-Yarza EG, Moreno A, Lázaro P, Mejías A, Ramilo O. The association between respiratory syncytial virus infection and the development of childhood asthma: a systematic review of the literature. Pediatr Infect Dis J 2007; 26:733-9. [PMID: 17848887 DOI: 10.1097/inf.0b013e3180618c42] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The relation between early respiratory syncytial virus (RSV) infection and later emergence of episodes of wheezing/asthma remains a subject of debate. We carried out a systematic review of studies of the association between RSV infection in the first 36 months of life and the subsequent development of asthma/bronchial hyperreactivity. METHODS A literature search for original studies on RSV respiratory infection published in English or Spanish over the last 21 years was conducted in the bibliographic databases Medline, Embase, and Indice Médico Español, and in the Cochrane library. Articles were included if they described original studies of confirmed RSV infection in children under 3 years of age, and had defined outcome variables. The methodologic quality of articles included in the review was evaluated according to the Hadorn criteria. RESULTS The review included 12 original articles that respond to the research question. The studies evaluated showed that RSV lower respiratory tract infection is associated with an increased risk for subsequent development of asthma/recurrent wheezing, and that this association becomes progressively smaller with increasing age. CONCLUSION On the basis of this systematic review of the literature, it can be concluded that a significant association exists between RSV infection in childhood and the long-term development of subsequent episodes of recurrent wheezing or asthma. However, the methodologic quality of the articles evaluated is limited, and hence additional studies are needed, ideally, with specific therapeutic interventions aimed at reducing RSV replication.
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