Wheezing rhinovirus illnesses in early life predict asthma development in high-risk children.
BACKGROUND
Virus-induced wheezing episodes in infancy often precede the development of asthma. Whether infections with specific viral pathogens confer differential future asthma risk is incompletely understood.


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


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


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


CONCLUSIONS
Among outpatient viral wheezing illnesses in infancy and early childhood, those caused by RV infections are the most significant predictors of the subsequent development of asthma at age 6 years in a high-risk birth cohort.
Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA. djj@medicine.wisc.edu
Daniel J
DJ
Jackson
Ronald E
RE
Gangnon
Michael D
MD
Evans
Kathy A
KA
Roberg
Elizabeth L
EL
Anderson
Tressa E
TE
Pappas
Magnolia C
MC
Printz
Wai-Ming
WM
Lee
Peter A
PA
Shult
Erik
E
Reisdorf
Kirsten T
KT
Carlson-Dakes
Lisa P
LP
Salazar
Douglas F
DF
DaSilva
Christopher J
CJ
Tisler
James E
JE
Gern
Robert F
RF
Lemanske
D001249:Asthma / Q000821:virology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007114:Immunization; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D010850:Picornaviridae Infections / Q000276:immunology*; D011446:Prospective Studies; D012135:Respiratory Sounds / Q000276:immunology*; D018357:Respiratory Syncytial Virus Infections / Q000276:immunology*; D012307:Risk Factors; D012882:Skin Tests