Effect of antibiotic use for acute bronchiolitis on new-onset asthma in children

I.-Lun Chen,Ting-Yi Wu,Wei-Ju Yeh,Chih-Hsing Hung,San-Nan Yang,Hsin-Chun Huang,Hsin-Yi Huang,Jau-Ling Suen,Yu-Han Chang

doi:10.1038/s41598-018-24348-5

Abstract

Early-life use of antibiotics is associated with asthma. We examined the effect of antibiotic use for early-life bronchiolitis on the development of new-onset asthma in children from Taiwan between 2005 and 2010. Data were from the National Health Insurance Research Database 2010, and diseases were coded using the International Classification of Disease (ICD). We classified the patients, all of whom had bronchiolitis, as having asthma or not having asthma. Asthma was diagnosed using ICD criteria and by use of an inhaled bronchodilator and/or corticosteroid twice in one year. We identified age at asthma onset, sex, residential area, history of atopy and NSAID use, age at first use of antibiotics, and the specific antibiotic, and adjusted for these factors using conditional logistic regression analysis. Among all individuals, there was a relationship between risk of new-onset asthma with use of a high dose of an antibiotic (adjusted odds ratio [aOR] = 3.33, 95% confidence interval [CI] = 2.67–4.15). Among the different antibiotics, macrolides (aOR = 2.87, 95% CI = 1.99–4.16), and azithromycin specifically (aOR = 3.45, 95% CI = 1.62–7.36), had the greatest effect of development of asthma.

Highlights

Environmental and genetic factors play important roles in the development of asthma
Our results indicate that early use of antibiotics in children with acute bronchiolitis is significantly associated with the development of new-onset asthma
The respiratory syncytial virus (RSV) and rhinovirus are the two most common pathogens in acute bronchiolitis[12], and infection with either virus increases the risk for allergic diseases

Summary

Introduction

Environmental and genetic factors play important roles in the development of asthma. In particular, the “hygiene hypothesis” proposes that growing up in a hygienic environment, with reduced exposure to microbes, promotes T-helper type 2 (Th2) immunity[1]. Among babies younger than 1 year-old, acute bronchiolitis (a lower respiratory tract infection) is the leading cause of hospitalization due to recurrent wheezing episodes, and a history of bronchiolitis during infancy is associated with an increased risk for development of asthma[4]. Another study demonstrated that rhinovirus-induced wheezing within the first 3 years of life was associated with a nearly 10-fold increased risk for development of asthma by age six[6]. Use of antibiotics early in life and a history of bronchiolitis increase the risk for asthma in young adolescents[9]. The aim of this study, which used the Taiwan National Health Insurance Research Database (NHIRD) 2010 database, was to assess the relationship of early-life antibiotic use for bronchiolitis with new-onset asthma in children

Methods

Results

Conclusion