Viral Etiology Of Early Life Wheezing Illnesses Differentially Predict Persistence Of Asthma In High-Risk Children

Abstract

RationaleViral wheezing illnesses in early childhood have been shown to predict development of asthma by 6 years of age. Whether a differential effect on the risk for persistence of asthma out to age 11 years exists based on viral etiology of early childhood wheezing illnesses has not been established.Methods217 children were followed prospectively from birth to 11 years in the COAST (Childhood Origins of ASThma) study. The etiology of viral wheezing illnesses during early childhood was determined using nasal lavage, culture and RT-PCR. Asthma was diagnosed clinically at 11 years. Relationships between the etiology of wheezing illnesses and asthma risk were analyzed.ResultsIn univariate analyses, wheezing illnesses in the first 3 years of life with HRV (OR=6.0 95% CI 2.1, 11, p<0.0001), RSV (OR=2.9 95% CI 1.6, 5.4, p=0.0008) and other viruses (OR=4.8 95% CI 2.6, 9.1, p<0.0001) were all associated with an increased risk of asthma at age 11. Using a multivariate model to adjust for histories of wheezing with more than one virus, the risk of asthma at age 11 years was significantly increased in children with HRV wheezing histories (OR=3.7 95% CI 1.7, 7.8, p=0.0008), but not in children who wheezed with RSV (OR=1.4 95% CI 0.7, 2.9, p=0.4) or other viruses (OR=2.1 95% CI 0.9, 4.7, p=0.08).ConclusionsViral etiology of wheezing illnesses in the first three years of life confers a differential risk for persistent asthma out to 11 years of age with wheezing due to HRV being the strongest overall predictor of this development. RationaleViral wheezing illnesses in early childhood have been shown to predict development of asthma by 6 years of age. Whether a differential effect on the risk for persistence of asthma out to age 11 years exists based on viral etiology of early childhood wheezing illnesses has not been established. Viral wheezing illnesses in early childhood have been shown to predict development of asthma by 6 years of age. Whether a differential effect on the risk for persistence of asthma out to age 11 years exists based on viral etiology of early childhood wheezing illnesses has not been established. Methods217 children were followed prospectively from birth to 11 years in the COAST (Childhood Origins of ASThma) study. The etiology of viral wheezing illnesses during early childhood was determined using nasal lavage, culture and RT-PCR. Asthma was diagnosed clinically at 11 years. Relationships between the etiology of wheezing illnesses and asthma risk were analyzed. 217 children were followed prospectively from birth to 11 years in the COAST (Childhood Origins of ASThma) study. The etiology of viral wheezing illnesses during early childhood was determined using nasal lavage, culture and RT-PCR. Asthma was diagnosed clinically at 11 years. Relationships between the etiology of wheezing illnesses and asthma risk were analyzed. ResultsIn univariate analyses, wheezing illnesses in the first 3 years of life with HRV (OR=6.0 95% CI 2.1, 11, p<0.0001), RSV (OR=2.9 95% CI 1.6, 5.4, p=0.0008) and other viruses (OR=4.8 95% CI 2.6, 9.1, p<0.0001) were all associated with an increased risk of asthma at age 11. Using a multivariate model to adjust for histories of wheezing with more than one virus, the risk of asthma at age 11 years was significantly increased in children with HRV wheezing histories (OR=3.7 95% CI 1.7, 7.8, p=0.0008), but not in children who wheezed with RSV (OR=1.4 95% CI 0.7, 2.9, p=0.4) or other viruses (OR=2.1 95% CI 0.9, 4.7, p=0.08). In univariate analyses, wheezing illnesses in the first 3 years of life with HRV (OR=6.0 95% CI 2.1, 11, p<0.0001), RSV (OR=2.9 95% CI 1.6, 5.4, p=0.0008) and other viruses (OR=4.8 95% CI 2.6, 9.1, p<0.0001) were all associated with an increased risk of asthma at age 11. Using a multivariate model to adjust for histories of wheezing with more than one virus, the risk of asthma at age 11 years was significantly increased in children with HRV wheezing histories (OR=3.7 95% CI 1.7, 7.8, p=0.0008), but not in children who wheezed with RSV (OR=1.4 95% CI 0.7, 2.9, p=0.4) or other viruses (OR=2.1 95% CI 0.9, 4.7, p=0.08). ConclusionsViral etiology of wheezing illnesses in the first three years of life confers a differential risk for persistent asthma out to 11 years of age with wheezing due to HRV being the strongest overall predictor of this development. Viral etiology of wheezing illnesses in the first three years of life confers a differential risk for persistent asthma out to 11 years of age with wheezing due to HRV being the strongest overall predictor of this development.