Asthma and lower airway disease
Decreased lung function after preschool wheezing rhinovirus illnesses in children at risk to develop asthma

https://doi.org/10.1016/j.jaci.2011.06.037Get rights and content

Background

Preschool rhinovirus (RV) wheezing illnesses predict an increased risk of childhood asthma; however, it is not clear how specific viral illnesses in early life relate to lung function later on in childhood.

Objective

To determine the relationship of virus-specific wheezing illnesses and lung function in a longitudinal cohort of children at risk for asthma.

Methods

Two hundred thirty-eight children were followed prospectively from birth to 8 years of age. Early life viral wheezing respiratory illnesses were assessed by using standard techniques, and lung function was assessed annually by using spirometry and impulse oscillometry. The relationships of these virus-specific wheezing illnesses and lung function were assessed by using mixed-effect linear regression.

Results

Children with RV wheezing illness demonstrated significantly decreased spirometry values, FEV1 (P = .001), FEV0.5 (P < .001), FEF25-75 (P < .001), and also had abnormal impulse oscillometry measures—more negative reactance at 5 Hz (P < .001)—compared with those who did not wheeze with RV. Children who wheezed with respiratory syncytial virus or other viral illnesses did not have any significant differences in spirometric or impulse oscillometry indices when compared with children who did not. Children diagnosed with asthma at ages 6 or 8 years had significantly decreased FEF25-75 (P = .05) compared with children without asthma.

Conclusion

Among outpatient viral wheezing illnesses in early childhood, those caused by RV infections are the most significant predictors of decreased lung function up to age 8 years in a high-risk birth cohort. Whether low lung function is a cause and/or effect of RV wheezing illnesses is yet to be determined.

Key words

Rhinovirus
respiratory syncytial virus
wheezing
asthma
spirometry
impulse oscillometry

Abbreviations used

ATS
American Thoracic Society
COAST
Childhood Origins of ASThma study
FEIA
Fluorescent enzyme immunoassay
IOS
Impulse oscillometry
RSV
Respiratory syncytial virus
RV
Rhinovirus

Cited by (0)

This study was supported by National Institutes of Health (NIH) grants R01 HL61879, P01 HL70831, and M01 RR03186.

Disclosure of potential conflict of interest: T. W. Guilbert has consultant arrangements with GlaxoSmithKline, AstraZeneca, MAP Pharmaceutical, Merck/Schering-Plough, and Genentech/Novartis; has received honororia from Peerpoint Medical Education Institute; has received research support from Altus Pharmaceuticals, Inspire Pharmaceuticals, the NHLBI, and the NIH; and is a member of the American Lung Association, the American Thoracic Society, and the American Academy of Pediatrics. D. J. Jackson has received research support from the AAAAI/GlaxoSmithKline. J. E. Gern has stock options in EraGen Biosciences. R. F. Lemanske, Jr has consultant arrangements with Merck & Co, Inc, AstraZeneca, and GlaxoSmithKline; is an author for Up to Date; and is on the speakers' bureau for the Michigan Public Health Institute. R. Burton has consultant arrangements with Carefusion (ERT). The rest of the authors have declared that they have no conflict of interest.

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