Original Article
Rhinovirus Type in Severe Bronchiolitis and the Development of Asthma

https://doi.org/10.1016/j.jaip.2019.08.043Get rights and content

Background

Respiratory syncytial virus (RSV)- and rhinovirus (RV)-induced bronchiolitis are associated with an increased risk of asthma, but more detailed information is needed on virus types.

Objective

To study whether RSV or RV types are differentially associated with the future use of asthma control medication.

Methods

Over 2 consecutive winter seasons (2008-2010), we enrolled 408 children hospitalized for bronchiolitis at age less than 24 months into a prospective, 3-center, 4-year follow-up study in Finland. Virus detection was performed by real-time reverse transcription PCR from nasal wash samples. Four years later, we examined current use of asthma control medication.

Results

A total of 349 (86%) children completed the 4-year follow-up. At study entry, the median age was 7.5 months, and 42% had RSV, 29% RV, 2% both RSV and RV, and 27% non-RSV/-RV etiology. The children with RV-A (adjusted hazard ratio, 2.3; P = .01), RV-C (adjusted hazard ratio, 3.5; P < .001), and non-RSV/-RV (adjusted hazard ratio, 2.0; P = .004) bronchiolitis started the asthma control medication earlier than did children with RSV bronchiolitis. Four years later, 27% of patients used asthma control medication; both RV-A (adjusted odds ratio, 3.0; P = .03) and RV-C (adjusted odds ratio, 3.7; P < .001) etiology were associated with the current use of asthma medication. The highest risk was found among patients with RV-C, atopic dermatitis, and fever (adjusted odds ratio, 5.0; P = .03).

Conclusions

Severe bronchiolitis caused by RV-A and RV-C was associated with earlier initiation and prolonged use of asthma control medication. The risk was especially high when bronchiolitis was associated with RV-C, atopic dermatitis, and fever.

Key words

Asthma development
Bronchiolitis
Respiratory syncytial virus
Rhinovirus
Wheeze
Wheezing

Abbreviations used

aHR
Adjusted hazard ratio
aOR
Adjusted odds ratio
HR
Hazard ratio
OR
Odds ratio
RSV
Respiratory syncytial virus
RV
Rhinovirus

Cited by (0)

This study was supported by the Sigrid Jusélius Foundation, the Paulo Foundation, the Foundation for Pediatric Research, and the Allergy Research Foundation, all in Helsinki, Finland.

Conflicts of interest: The authors declare that they have no relevant conflicts of interest.

Equally contributing first authors.

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