RHINOVIRUS AND RECURRENT WHEEZE IN CHILDREN ADMITTED TO THE ICU FOR NEW ONSET WHEEZING

Abstract

SESSION TITLE: Pediatrics SESSION TYPE: Original Investigations PRESENTED ON: 10/20/2019 2:15 PM - 3:15 PM PURPOSE: Viruses commonly trigger bronchospasm in children, with rhinovirus being the most common trigger for pediatric asthma exacerbations as well as new wheezing in children. Rhinovirus has also been associated with recurrent wheezing in children without known asthma. The role of rhinovirus in acute first-time wheezing requiring pediatric ICU (PICU) admission and the risk of recurrent wheezing is unknown. METHODS: We conducted a retrospective cohort study of children without prior wheezing admitted to our PICU in 2013 for acute wheezing. We evaluated characteristics of these children, including age, viral status and family history of asthma; as well as post-discharge management including controller prescription and outpatient pulmonology follow-up. We also examined the association between rhinovirus status and subsequent severe wheezing defined as a composite of urgent care (UC)/emergency department (ED) visit or re-admission for wheezing over the subsequent 3 years. RESULTS: 59 children requiring PICU admission with new wheezing were evaluated. 56% had a family history of asthma and 31% had other atopic diseases. The median age was 20 months with over half (54%) under 2 years old. Rhinovirus was the most common identified trigger (42%), while 37% had other viruses and 27% had no virus. Only 4 of 25 with rhinovirus tested positive for an additional virus (1 RSV, 2 adenovirus, 1 human metapneumovirus). 53% of all patients were prescribed an inhaled corticosteroid at hospital discharge, and 37% had outpatient pulmonology follow-up. There were 14 patients (24%) who required subsequent admission and an additional 18 who had ED/UC visits for acute wheezing. 72% of rhinovirus patients required subsequent admission/ED/UC compared to 41% of non-rhinovirus patients. In univariate logistic regression, rhinovirus had an OR of 3.67 (95%CI 1.21,11.1; p=0.02) for our composite outcome compared to non-rhinovirus patients. The only other factor associated with this outcome was age < 2, family asthma history, personal atopic history, controller prescription, and pulmonology follow-up. CONCLUSIONS: In children requiring ICU admission for first-time wheezing, rhinovirus was associated with subsequent ED/UC visits and hospital admission for wheezing. It is not clear from our data whether these patients have true asthma. CLINICAL IMPLICATIONS: Further research is needed to better characterize the impact of rhinovirus on long-term outcomes and ways to reduce morbidity for children admitted to the ICU for new wheezing, but our data suggest that strategies to address recurrent wheezing, such as outpatient follow-up or controller medications, could be considered to reduce morbidity in these patients. DISCLOSURES: No relevant relationships by Todd Karsies, source=Web Response No relevant relationships by Rasika Venkatraman, source=Web Response