Asthma and allergy patterns over 18 years after severe RSV bronchiolitis in the first year of life.
BACKGROUND
An increased prevalence of asthma/recurrent wheeze (RW), clinical allergy and allergic sensitisation up to age 13&emsp14;years has previously been reported in subjects hospitalised with respiratory syncytial virus (RSV) bronchiolitis in their first year of life compared with matched controls. A study was undertaken to examine whether these features persist into early adulthood, to report longitudinal wheeze and allergy patterns, and to see how large and small airway function relates to RSV infection and asthma.


METHODS
Follow-up at age 18 years was performed in 46 of 47 subjects with RSV and 92 of 93 controls. Assessments included questionnaire, clinical examination, skin prick tests, serum IgE antibodies to inhaled allergens, blood eosinophils, fraction of exhaled nitric oxide (FeNO), spirometry, multiple breath washout (lung clearance index, LCI) and dry air hyperventilation challenge.


RESULTS
Increased prevalence of asthma/RW (39% vs 9%), clinical allergy (43% vs 17%) and sensitisation to perennial allergens (41% vs 14%) were present at age 18 in the RSV cohort compared with controls. Persistent/relapsing wheeze associated with early allergic sensitisation predominated in the RSV cohort compared with controls (30% vs 1%). Spirometric function was reduced in subjects with RSV with or without current asthma, but not in asthmatic controls. LCI was linked only to current asthma, airway hyperresponsiveness and FeNO.


CONCLUSIONS
Severe early RSV bronchiolitis is associated with an increased prevalence of allergic asthma persisting into early adulthood. Small airway dysfunction (LCI) is related to current asthma and airway inflammation but not to RSV bronchiolitis. Reduced spirometry after RSV may reflect airway remodelling.
Sigurs
Nele
N
Department of Paediatrics, Borås Central Hospital, Borås S-50182, Sweden. nele.sigurs@vgregion.se
Aljassim
Fatma
F
Kjellman
Bengt
B
Robinson
Paul D
PD
Sigurbergsson
Fridrik
F
Bjarnason
Ragnar
R
Gustafsson
Per M
PM
D001249:Asthma / Q000503:physiopathology / Q000821:virology*; D001990:Bronchiolitis, Viral / Q000150:complications*; D004812:Epidemiologic Methods; D005260:Female; D006760:Hospitalization; D006801:Humans; D006967:Hypersensitivity / Q000503:physiopathology / Q000821:virology; D007223:Infant; D007231:Infant, Newborn; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D012123:Pulmonary Ventilation / Q000502:physiology; D012135:Respiratory Sounds / Q000209:etiology / Q000503:physiopathology; D018357:Respiratory Syncytial Virus Infections / Q000150:complications*; D012882:Skin Tests / Q000379:methods; D014797:Vital Capacity / Q000502:physiology
D018836:Inflammation Mediators