Increased incidence of bronchial reactivity in children with a history of bronchiolitis

doi:10.1016/S0022-3476(81)80758-5

The Journal of Pediatrics

Volume 98, Issue 4, April 1981, Pages 551-555

https://doi.org/10.1016/S0022-3476(81)80758-5 Get rights and content

To assess bronchial reactivity in children who have had bronchiolitis, we studied 48 children by challenging them with methacholine nine or ten years after admission to hospital with bronchiolitis. Pulmonary function was also evaluated. Fifty-seven percent of children studied had bronchial hyperreactivity. Thirty-three percent of first-degree relatives of those with a positive MCH challenge had a positive response. There was a significant correlation between the occurrence of a positive MCH challenge and a history of recurrent bronchiolitis. Pulmonary function tests demonstrated lower flow rates in the positive responders. Fourteen children had a history of asthma or wheezing, but this did not appear to be severe or frequent, and few required long-term therapy. There appears to be a strong genetic component in the prevalence of bronchial reactivity in these children. Bronchial hyperreactivity may be a risk factor in the development of COPD.

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This chapter reviews antiviral treatments of interest to decrease the risk for childhood-onset asthma. Most antiviral options are aimed at treating the acute effects of virus infection that provoke wheezing or are prophylactic treatments administered to high-risk infants. Alternatively, antiviral vaccines would have the advantage of stimulating an adaptive immune response to modify the adverse effects of the same viral pathogen later on. However, effective vaccines for the respiratory syncytial virus and rhinovirus, the pathogens most often associated with wheezing, have been difficult to produce. Other environmental risk factors, in particular sensitization and exposure to environmental allergens, also influence the development of asthma. Thus, it may be necessary to combine specific antiviral treatments with methods to counter the adverse effects of allergic inflammation, and/or to normalize gut, skin, and airway microbiota to decrease the risk for future wheeze.
The Role of Antiviral Strategies for the Prevention of Childhood Asthma
2015, Allergy, Immunity and Tolerance in Early Childhood: The First Steps of the Atopic March
This chapter reviews antiviral treatments of interest to decrease the risk for childhood-onset asthma. Most antiviral options are aimed at treating the acute effects of virus infection that provoke wheezing or are prophylactic treatments administered to high-risk infants. Alternatively, antiviral vaccines would have the advantage of stimulating an adaptive immune response to modify the adverse effects of the same viral pathogen later on. However, effective vaccines for the respiratory syncytial virus and rhinovirus, the pathogens most often associated with wheezing, have been difficult to produce. Other environmental risk factors, in particular sensitization and exposure to environmental allergens, also influence the development of asthma. Thus, it may be necessary to combine specific antiviral treatments with methods to counter the adverse effects of allergic inflammation, and/or to normalize gut, skin, and airway microbiota to decrease the risk for future wheeze.
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The main goal of the paper was to assess the pattern of risk factors having an impact on the onset of early wheezing phenotypes in the birth cohort of 468 two-year olds and to investigate the severity of respiratory illness in the two-year olds in relation to both wheezing phenotypes, environmental tobacco smoke (ETS) and personal PM_2.5 exposure over pregnancy period (fine particulate matter). The secondary goal of the paper was to assess possible association of early persistent wheezing with the length of the baby at birth. Pregnant women were recruited from ambulatory prenatal clinics in the first and second trimester of pregnancy. Only women 18–35 years of age, who claimed to be non-smokers, with singleton pregnancies, without illicit drug use and HIV infection, free from chronic diseases were eligible for the study. In the statistical analysis of respiratory health of children multinomial logistic regression and zero-inflated Poisson regression models were used. Approximately one third of the children in the study sample experienced wheezing in the first 2 years of life and in about two third of cases (67%) the symptom developed already in the first year of life. The early wheezing was easily reversible and in about 70% of infants with wheezing the symptom receded in the second year of life. The adjusted relative risk ratio (RRR) of persistent wheezing increased with maternal atopy (RRR = 3.05; 95%CI: 1.30–7.15), older siblings (RRR = 3.05; 95%CI: 1.67–5.58) and prenatal ETS exposure (RRR = 1.13; 95%CI: 1.04–1.23), but was inversely associated with the length of baby at birth (RRR = 0.88; 95%CI: 0.76–1.01). The adjusted incidence risk ratios (IRR) of coughing, difficult breathing, runny/stuffy nose and pharyngitis/tonsillitis in wheezers were much higher than that observed among non-wheezers and significantly depended on prenatal PM_2.5 exposure, older siblings and maternal atopy. The study shows a clear inverse association between maternal age or maternal education and respiratory illnesses and calls for more research efforts aiming at the explanation of factors hidden behind proxy measures of quality of maternal care of babies. The data support the hypothesis that burden of respiratory symptoms in early childhood and possibly in later life may be programmed already in prenatal period when the respiratory system is completing its growth and maturation.
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Citation Excerpt :
These studies highlight the different pathogens associated with wheezing illnesses by age and the association of rhinovirus and atopy with wheezing in children beyond infancy. The association between bronchiolitis during infancy and the development of asthma has been an area of interest for decades [4,47–74]. Most, but not all, previous studies have primarily included case infants who were hospitalized with bronchiolitis during infancy.
The etiology and morbidity associated with asthma are thought to stem from both genetic factors and potentially modifiable environmental factors, such as viral infections. Although it is unclear whether respiratory viral infections cause asthma, observational studies have demonstrated a high rate of asthma in children with a history of severe viral lower respiratory tract infections during infancy, and viruses are associated with the majority of asthma exacerbations among both children and adults. This article discusses the pathogens associated with virus-induced wheezing illnesses during infancy and early childhood, the association of bronchiolitis during infancy with an increased risk of childhood asthma, and the association of respiratory viruses with asthma exacerbations in older children and adults.

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Original articleIncreased incidence of bronchial reactivity in children with a history of bronchiolitis

J Allergy

J Pediatr

J Allergy

J Allergy Clin Immunol

J Pediatr

J Allergy

Respiratory syncytial viruses

The relationship of acute bronchiolitis to bronchial asthma—a 4 to 14-year follow-up

Pediatrics

Study of 8-year-old children with a history of respiratory syncytial virus bronchiolitis in infancy

Br Med J

Bronchial hyperreactivity

Am Rev Respir Dis

Airway reactivity and the need for a simple test

Am Rev Respir Dis

Pulmonary function abnormalities in symptom-free children after bronchiolitis

Pediatrics

Original article
Increased incidence of bronchial reactivity in children with a history of bronchiolitis