Mari Hyvärinen

Teenage asthma after severe early childhood wheezing: an 11-year prospective follow-up.

The role of factors related to early wheezing and their associations with subsequent development of asthma are controversial. We reevaluated 81 children who had been prospectively followed up since hospitalization for wheezing at less than 2 years of age. The baseline data on characteristics of the children, family‐related factors, and viral causes of wheezing were collected on entry into the study. At the median age of 12.3 years, current symptoms suggestive of asthma and allergy were recorded. As part of the clinical examination, an outdoor exercise challenge test and skin prick tests to common inhalant allergens were performed. Asthma, as indicated by current inhaled anti‐inflammatory medication or repeated wheezing and positive result in the challenge test, was present in 32 (40%) children, and 90% of them were sensitized to at least one allergen. Early asthma‐predictive factors were atopic dermatitis (odds ratio (OR), 3.5; 95% confidence interval (CI), 1.2–10.1) and the presence of specific IgE to inhalant allergens (OR, 11.3; 95% CI, 1.9–67.6). Respiratory syncytial virus (RSV) identification during wheezing in infancy was relatively rare (20%) among later asthmatics compared with other or no viral identification (52%) or rhinovirus identification (58%). Since the prevalence of childhood asthma in our area is 4.0–5.0%, we conclude that the increased risk of asthma persists until the teenage years after hospitalization for wheezing in infancy. The risk was about 5‐fold after respiratory syncytial virus‐induced wheezing, and more than 10‐fold after rhinovirus‐induced wheezing in the present study. Pediatr Pulmonol.

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.

Lung function and bronchial hyper‐responsiveness 11 years after hospitalization for bronchiolitis

Aim: Atopic infants hospitalized for wheezing not caused by respiratory syncytial virus (RSV) carry the highest risk for later asthma. In the present paper, early risk factors for later lung function abnormalities and for bronchial hyper‐responsiveness (BHR) were evaluated in 81 children, hospitalized for bronchiolitis in infancy, at the median age of 12.3 years.

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.

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.

Overweight does not increase asthma risk but may decrease allergy risk at school age after infantile bronchiolitis

Aim:  Increasing evidence suggests that overweight children are at increased risk of asthma. The association between weight gain and allergy is more complex. The aim was to evaluate the association between overweight or obesity and asthma, allergy, bronchial reactivity or atopic sensitization at school age in children with bronchiolitis in infancy.

No association between overweight and asthma or allergy in adolescence after wheezing in infancy

The aim of the study was to evaluate the association between weight status and asthma, allergy and respiratory symptoms in adolescents with bronchiolitis in infancy.