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Thorax 65:1045-1052 doi:10.1136/thx.2009.121582
  • Asthma
  • Original article

Asthma and allergy patterns over 18 years after severe RSV bronchiolitis in the first year of life

  1. Per M Gustafsson2,4,9
  1. 1Department of Paediatrics, Borås Central Hospital, Borås, Sweden
  2. 2Queen Silvia Children's Hospital, Göteborg, Sweden
  3. 3Department of Paediatrics, Alwasl Hospital, Dubai Health Authority, Government of Dubai, UAE
  4. 4Department of Paediatrics, Central Hospital, Skövde, Sweden
  5. 5Department of Respiratory Medicine, The Children's Hospital at Westmead, Australia
  6. 6The Children's Hospital at Westmead Clinical School, Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Australia
  7. 7Emergency Department, Landspitali University Hospital, Reykjavik, Iceland
  8. 8University of Iceland, Department of Paediatrics, Landspitali University Hospital Iceland, Reykjavik, Iceland
  9. 9The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
  1. Correspondence to Dr Nele Sigurs, Department of Paediatrics, Borås Central Hospital, Borås S-50182, Sweden; nele.sigurs{at}vgregion.se
  • Received 14 June 2009
  • Accepted 2 April 2010
  • Published Online First 27 June 2010

Abstract

Background An increased prevalence of asthma/recurrent wheeze (RW), clinical allergy and allergic sensitisation up to age 13 years has previously been reported in subjects hospitalised with respiratory syncytial virus (RSV) bronchiolitis in their first year of life compared with matched controls. A study was undertaken to examine whether these features persist into early adulthood, to report longitudinal wheeze and allergy patterns, and to see how large and small airway function relates to RSV infection and asthma.

Methods Follow-up at age 18 years was performed in 46 of 47 subjects with RSV and 92 of 93 controls. Assessments included questionnaire, clinical examination, skin prick tests, serum IgE antibodies to inhaled allergens, blood eosinophils, fraction of exhaled nitric oxide (FeNO), spirometry, multiple breath washout (lung clearance index, LCI) and dry air hyperventilation challenge.

Results Increased prevalence of asthma/RW (39% vs 9%), clinical allergy (43% vs 17%) and sensitisation to perennial allergens (41% vs 14%) were present at age 18 in the RSV cohort compared with controls. Persistent/relapsing wheeze associated with early allergic sensitisation predominated in the RSV cohort compared with controls (30% vs 1%). Spirometric function was reduced in subjects with RSV with or without current asthma, but not in asthmatic controls. LCI was linked only to current asthma, airway hyperresponsiveness and FeNO.

Conclusions Severe early RSV bronchiolitis is associated with an increased prevalence of allergic asthma persisting into early adulthood. Small airway dysfunction (LCI) is related to current asthma and airway inflammation but not to RSV bronchiolitis. Reduced spirometry after RSV may reflect airway remodelling.

Footnotes

  • Linked articles 133967.

  • Funding The study was supported by grants from the Regional Health Care Authority of West Sweden, from Borås Hospital, the Fokus Foundation and SeBe's Fund.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Human Research Committee of the Medical Faculty at the University of Gothenburg. All parents and subjects gave consent to the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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