Action not words, please!

Does Respiratory Syncytial Virus (RSV) cause asthma, or is merely a marker for an asthmatic tendency. The sceptics point to the impaired pre-morbid lung function and the immunological changes in cord blood preceding RSV infection, and the Tucson data showing that post-RSV symptoms gradually recede as time goes by. The true believers principally cite the meticulously conducted follow up studies led by Dr Nele Sigurs, showing a high prevalence of asthma in the years following severe RSV infection. We here feature another instalment of the Tucson versus Sweden controversy. The original Sigurs cohort has been restudied with almost 100% retention, an amazing feat. The previously reported high prevalence of allergic asthma was shown to persist to age 18. In an accompanying editorial, Stein and Martinez speculate that early RSV and later asthma are both manifestations of an underlying innate immune dysregulation. How much longer do we have to endure words not action? The only way to settle an issue of enormous public health importance is to randomise high risk infants to the anti-RSV monoclonal or placebo, and follow them up to see if (a) RSV infection is prevented, and (b) whether …