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Will preventing acute respiratory syncytial virus infections reduce the risk of subsequent wheezing?
Lucina has followed the Respiratory Syncytial Virus (RSV) and asthma debate over thirty years. Do lower respiratory tract infections (LRTIs) with RSV cause chronic wheezing illnesses? If RSV-LRTI were causal, we would expect RSV-LRTI prevention to reduce the incidence of chronic wheezing illnesses in addition to reducing acute disease. What is the strength of evidence for a causal effect of RSV-LRTI on subsequent chronic wheezing illness? The answer to this question should inform public health expectations for RSV vaccines. Brunwasser SM et al. [Lancet Respiratory Medicine 2020;8:795–806] has completed a systematic review and meta-analysis of observational studies evaluating the association between RSV-LRTI and subsequent wheezing illness (exposure studies) and studies evaluating the association between RSV immunoprophylaxis and subsequent wheezing illness (immunoprophylaxis studies). Over 14 235 records were identified, 57 eligible articles that described 42 studies and provided 153 effect estimates. Exposure studies that adjusted for genetic influences yielded a smaller mean adjusted OR estimate (aOR +2·45, 95% CI 1·23–4·88) compared with those that did not (4·17, 2·36–7·37), a significant difference (b 0·53, 95% CI 0·04–1·02). Infants who were not protected with RSV immunoprophylaxis tended to have higher odds of subsequent wheezing illness, as we would expect if RSV-LRTI were causal, but the effect was not significant (OR +1·21, 95% CI 0·73–1·99). …
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