Eija Piippo-Savolainen

Wheezy babies--wheezy adults? Review on long-term outcome until adulthood after early childhood wheezing.

Population‐based birth cohort studies have documented that about 30% of children suffer from wheezing during respiratory infection before their third birthday. Recurrent wheezing is common in early childhood, but most patients outgrow their symptoms by school age. However, recent long‐term postbronchiolitis follow‐up studies from Sweden and Finland have revealed that asthma is present in about 40% of young adults and over half of the cases are relapses after many symptom‐free years.

Teenage asthma after severe infantile bronchiolitis or pneumonia

OBJECTIVE The purpose of the study was to evaluate asthma at >13 y of age in children with infantile bronchiolitis or pneumonia. METHODS In 1981-1982, 127 children at <2 y of age were hospitalized for bronchiolitis (n = 81) or pneumonia (n = 46). Respiratory syncytial virus (RSV) infection, eosinophilia and markers of atopy were assessed and recorded on admission. At a median age of 14.9 y, atopic and asthmatic symptoms were screened by a written questionnaire in 98/127 (77%) study subjects. RESULTS Asthma was present, according to two definitions, in 14% to 23% in the original bronchiolitis and in 12% to 15% in the original pneumonia group. The figures were 8% to 17% in the RSV infection and 16% to 23% in the non-RSV infection group. Early asthma-predictive factors were repeated wheezing, atopic dermatitis and elevated blood eosinophils. All but one of the teenage asthmatics had allergic rhinitis. CONCLUSION An increased risk for asthma persists until the teenage period after bronchiolitis and pneumonia in infancy. Both early and later atopy were significant risk factors. The present study was unable to demonstrate the association between early RSV infection and teenage asthma.

Adult asthma after non-respiratory syncytial virus bronchiolitis in infancy: Subgroup analysis of the 20-year prospective follow-up study

Background: Recent studies have stressed the influence of other viruses than respiratory syncytial virus (RSV) in the development of asthma in later childhood after bronchiolitis in infancy. However, the virus‐specific prognosis until adulthood has remained obscure, due to lack of sufficiently long follow‐up studies. The aim of the present study was to evaluate adult respiratory morbidity after bronchiolitis in infancy, focused on cases not caused by RSV.

Adolescent asthma after rhinovirus and respiratory syncytial virus bronchiolitis.

Asthma risk is increased after bronchiolitis in infancy. Recent studies have suggested that the risk may be dependent on the causative virus. The aim of the study was to evaluate the asthma risk in adolescence in subjects hospitalized for rhinovirus or respiratory syncytial virus (RSV) bronchiolitis in infancy.

Early exposure and sensitization to cat and dog: different effects on asthma risk after wheezing in infancy.

Birth cohort studies have suggested that early exposure to furred pets protects from later asthma and allergy. The aim of the present study was to evaluate the association between exposure or sensitization to cat or dog in infancy, and later asthma and allergy assessed at the median ages of 4.0, 7.2 and 12.3 yr, in children who have wheezed at <24 months of age. Exposure to cat and dog in infancy was assessed by interviewing the parents. The child was considered as sensitized, if the allergen‐specific IgE to cat or to dog was ≥0.35 kU/l, or if there was a positive skin test response. When the 20 children with persistent childhood asthma (doctor‐diagnosed asthma at all three control visits) were compared with the other 61 children, an early exposure to dog (OR = 0.14, p = 0.034)) decreased the asthma risk and an early sensitization to cat (OR = 5.92, p = 0.008) and dog (OR = 9.33, p = 0.001) increased the asthma risk. There were less cat and dog keeping in atopic families and the effect of sensitization was, but the effect of exposure was not, robust to adjustments in multivariate analyses. The present study demonstrates, in a long‐term follow‐up after early wheezing, that early sensitization to cat and dog increases the risk of later asthma but early exposure to cat or dog has no such effect. Dog keeping was less frequent in atopic families, which may explain that the protective effect of early exposure to dog was lost in multivariate analyses.

Increased asthma risk and impaired quality of life after bronchiolitis or pneumonia in infancy

Recent studies have revealed that adulthood asthma has its origin in early childhood.

Adults face increased asthma risk after infant RSV bronchiolitis and reduced respiratory health-related quality of life after RSV pneumonia

To evaluate the association between hospitalisation for respiratory syncytial virus lower respiratory tract infection (RSV LRTI) in infancy and asthma, respiratory health‐related quality of life and lung function at 28–31 years of age.

Respiratory morbidity in adulthood after respiratory syncytial virus hospitalization in infancy.

A prospective >25-year follow-up study evaluated the outcome of patients hospitalized for respiratory syncytial virus (RSV) infection at <24 months of age. Questionnaires were sent to 51 study subjects and to population controls. Self-reported asthma was present in 30% of the former RSV patients, compared with 3.8% of controls. In adjusted analyses, RSV hospitalization was an independent risk factor of adulthood asthma.

Eosinophil activity in infants hospitalized for wheezing and risk of persistent childhood asthma

Hyvärinen MK, Kotaniemi‐Syrjänen A, Reijonen TM, Piippo‐Savolainen E, Korppi M. Eosinophil activity in infants hospitalized for wheezing and risk of persistent childhood asthma.
Pediatr Allergy Immunol 2010: 21: 96–103.
© 2009 John Wiley & Sons A/S

Lung function and overweight in school aged children after early childhood wheezing

Recently, obesity has been connected with wheezing, asthma and reduced lung function. Most previous studies have been cross‐sectional. The aim of the present follow‐up study was to evaluate the association of preceding or current overweight or obesity with lung function at early and late school age after early childhood wheezing.