Airflow limitation during respiratory syncytial virus lower respiratory tract infection predicts recurrent wheezing.
BACKGROUND
Respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) is frequently followed by recurrent wheezing. Thus far no clinical risk factors have been identified to predict which infants will have wheezing episodes subsequent to RSV LRTI.


OBJECTIVE
To determine clinical predictors for airway morbidity after RSV LRTI.


METHODS
In a 1-year follow-up study we investigated the predictive value of auscultatory findings characteristic of airflow limitation (wheezing) during RSV LRTI for subsequent airway morbidity. Clinical characteristics, including the presence or absence of signs of airflow limitation, of hospitalized infants with RSV LRTI were prospectively recorded during 2 winter epidemics. During a 1-year follow-up period parents of 130 infants recorded daily airway symptoms.


METHODS
Recurrent wheezing defined as > or = 2 episodes of wheezing.


RESULTS
Signs of airflow limitation during RSV LRTI were absent in 47 (36%) infants and present in 83 (64%) infants. Recurrent wheezing was recorded in 10 (21%) infants without signs of airflow limitation and in 51 (61%) with signs of airflow limitation during initial RSV LRTI (relative risk, 0.29, P < 0.001). In a multiple logistic regression model, airflow limitation during initial RSV LRTI proved independent from other clinical parameters, including age, parental history of asthma and smoke exposure.


CONCLUSIONS
A sign of airflow limitation during RSV LRTI is the first useful clinical predictor for subsequent recurrent wheezing.
Bont
L
L
Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands.
Van Aalderen
W M
WM
Versteegh
J
J
Brus
F
F
Draaisma
J T
JT
Pekelharing-Berghuis
M
M
Van Diemen-Steenvoorde
R A
RA
Kimpen
J L
JL
D001314:Auscultation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009017:Morbidity; D012008:Recurrence; D012135:Respiratory Sounds / Q000209:etiology*; D018357:Respiratory Syncytial Virus Infections / Q000150:complications* / Q000821:virology; D018113:Respiratory Syncytial Virus, Human; D012141:Respiratory Tract Infections / Q000150:complications*