title: The relationship between RSV bronchiolitis and recurrent wheeze: the chicken and the egg.
abstract: Respiratory syncytial virus bronchiolitis is the most frequent cause of infant hospitalization. RSV bronchiolitis is often followed by recurrent episodes of wheeze. Pathogenesis of RSV bronchiolitis as well as post-bronchiolitis wheeze are incompletely understood. The aim of this review is to provide a brief overview of our current understanding of the complex pathogenesis of RSV bronchiolitis and post-bronchiolitis wheeze. Two non-exclusive hypotheses exist, which are paraphrased for this review as "the chicken and the egg". First, we reviewed the pre-existent genetic, pulmonary and immunological mechanisms of RSV bronchiolitis and post-bronchiolitis wheeze. Second, RSV as the causative virus of long-term airway morbidity is reviewed. Clearly, RSV infection is capable of causing direct damage to the airways and/or inducing long-term inappropriate immune responses to respiratory viruses or aero-allergens. It is concluded that intervention trials aimed at preventing RSV infections are required to establish the relative contribution of both RSV-induced and pre-existent mechanisms to the development of long-term airway disease following RSV bronchiolitis.
authors.affiliation: University Medical Centre Utrecht, Department of Pediatrics, PO Box 85090, 3508 AB, Utrecht, Netherlands. l.bont@umcutrecht.nl
authors.forename: L
authors.initials: L
authors.lastname: Bont
authors.forename: O
authors.initials: O
authors.lastname: Ramilo
mesh_terms: D000818:Animals; D001988:Bronchiolitis / Q000150:complications* / Q000453:epidemiology / Q000209:etiology*; D002645:Chickens; D004198:Disease Susceptibility / Q000150:complications / Q000151:congenital / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000209:etiology; D019365:Metaphor; D010063:Ovum; D012008:Recurrence; D012135:Respiratory Sounds / Q000209:etiology* / Q000502:physiology; D018357:Respiratory Syncytial Virus Infections / Q000150:complications* / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors