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DOI: 10.1055/s-0040-1716969
Influence of Previous Respiratory Infection on the Association between Respiratory Syncytial Virus Hospitalization and Childhood Asthma
Publication History
Publication Date:
08 September 2020 (online)
Introduction Respiratory syncytial virus hospitalization (RSVH) in early childhood has been associated with increased rates of asthma development. Whether certain children are susceptible to both severe RSV and asthma has not been fully elucidated. This study investigated the influence of respiratory infections before RSVH on asthma development.
Materials and Methods All children in Scotland born 1996 to 2011 were followed until 18 years or study end (2014) using Public Health Scotland databases. Children with RSVH (ICD-10: J12.1, J20.5, and 21.0) at ≤2 years old were grouped by previous hospital visits: none; upper respiratory tract infection (URTI: J00–J06); non-RSV bronchiolitis/bronchitis (BR: J20.1/2/3/4/6/7/8/9, J21.1/8/9, J22); or non-RSV viral/bacterial pneumonia (PN: J11.0, J12.0/2/3/8/9, J13-J18). Asthma hospitalizations (J45, J46), use of asthma medications, and a composite outcome of “confirmed asthma” (asthma admission and medication use) were assessed.
Results Main results are reported in [Table A005]. In summary, of 740,418 children, 15,795 (2.1%) had ≥1 RSVH at ≤2 years, with 12,764 (80.1%) not previously hospitalized. Asthma admissions were significantly higher in those with versus without a RSVH (8.4 vs. 2.4%, respectively; relative risk [RR]: 3.4, 95% confidence interval [CI]: 3.3–3.6, p < 0.0001). In those with no prior hospitalizations, asthma admissions were again significantly higher in children with RSVH (6.8%; relative risk [RR]: 2.8, 95% CI: 2.6–3.0 vs. non-RSVH; p < 0.0001). Asthma admissions were particularly raised in children with respiratory infections before RSVH: URTI 15.6% (RR: 6.4, 95% CI: 5.4–7.7; p < 0.0001 vs. non-RSVH); BR 21.9% (RR: 9.0, 95% CI: 7.8–10.3; p < 0.0001); PN 22.2% (RR: 9.1, 95% CI: 6.6–12.7; p < 0.0001). Children with respiratory infections before RSVH had significantly more asthma admissions than those with no hospitalizations before RSVH (URTI: RR: 2.3, 95% CI: 1.9–2.8; BR: RR: 3.2, 95% CI: 2.8–3.8; PN: 3.3, 95% CI: 2.3–4.6; all p < 0.0001). Similar results for asthma medication use and confirmed asthma were seen ([Table A005]).
Conclusion These results suggest that RSVH is an independent risk factor for asthma development, which is exacerbated in those with a history of respiratory infections.
|
Overall population |
RSVH occurred following |
|||||
|
RSVH |
Non-RSVH |
No previous hospitalization |
Upper respiratory infection hospitalization |
Bronchiolitis or bronchitis hospitalization not coded as RSV |
ViraiIbacterial pneumonia hospitalization not coded as RSV |
|
|
Asthma admission, % (n/N) |
8.4% (1,326/ 15,795) |
2.4% (17,641/724,623) |
6.8% (868/12,764) |
15.6% (97/620) |
21.9% (160/730) |
22.2% (28/126) |
|
Asthma admission rate/1,000 (N) |
193.2 (3,052) |
46.0 (33,351) |
140.4 (1,792) |
522.6 (324) |
634.2 (463) |
603.2 (76) |
|
Anti-asthma medication, % (n/N) |
25.5% (4,023/15,795) |
14.7% (106,828/724, 623) |
23.5% (3,004/12,764) |
36.3% (225/620) |
39.2% (286/730) |
33.3% (42/126) |
|
Confirmed asthma, % (n/N) |
4.8% (756/15,795) |
1.5% (10,655/724,623) |
3.9% (494/12,764) |
10.0% (62/620) |
12.3% (90/730) |
12.7% (16/126) |
Abbreviation: RSVH, respiratory syncytial virus hospitalization.
Conflict of Interest
None declared.
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No conflict of interest has been declared by the author(s).