Severe bronchiolitis profiles and risk of asthma development in Finnish children

Abstract

Recent studies support the existence of several entities under the clinical diagnosis of bronchiolitis. Among infants with severe bronchiolitis, distinct profiles have been differentially associated with development of recurrent wheezing by age 3 years. However, their associations with actual asthma remain unclear. Our aim was to study the association between severe bronchiolitis profiles identified by using a clustering approach and childhood asthma. Among 408 children (aged <2 years) hospitalized with bronchiolitis in Finland (in 2008-2010), latent class analysis identified 3 bronchiolitis profiles: profile A(47%), characterized by history of wheezing and/or eczema, wheezing during acute illness, and rhinovirus infection; profile BC (38%), characterized by severe illness and respiratory syncytial virus infection; and profile D (15%), characterized by the least severely ill children, including mostly children without wheezing and with rhinovirus infection. The children were followed by questionnaire 4 years later (86% [n= 348]) and through a nationwide social insurance database 7 years later (99% [n= 403]). Current asthma at the 4- and 7-year follow-ups was defined by regular use (according to parental report and medical records) or purchase (according to the social insurance database) of asthma control medication. Compared with risk of current asthma associated with profile BC, we observed increased risk of current asthma associated with profile Aboth at the 4-year follow-up (age- and sex-adjusted odds ratio= 2.42 [95% CI= 1.23-4.75]) and at the 7-year follow-up (age- and sex-adjusted odds ratio= 3.14 [95% CI= 1.33-7.42]). No significant difference in asthma risk was observed between profile D and profile BC. These longitudinal results provide further support for an association between a distinct severe bronchiolitis profile (characterized by a history of wheezing and/or eczema and rhinovirus infection) and risk of development childhood asthma.