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Original Article
A population-based prospective cohort study examining the influence of early-life respiratory tract infections on school-age lung function and asthma
  1. Evelien R van Meel1,2,3,
  2. Herman T den Dekker1,2,3,
  3. Niels J Elbert1,4,
  4. Pauline W Jansen5,6,
  5. Henriëtte A Moll7,
  6. Irwin K Reiss8,
  7. Johan C de Jongste2,
  8. Vincent W V Jaddoe1,3,7,
  9. Liesbeth Duijts2,3,8
  1. 1The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
  2. 2Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
  3. 3Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
  4. 4Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
  5. 5Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
  6. 6Institute of Psychology, Erasmus University Rotterdam, Rotterdam, Netherlands
  7. 7Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
  8. 8Division of Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
  1. Correspondence to Dr Liesbeth Duijts, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3000 CB, The Netherlands; l.duijts{at}erasmusmc.nl

Abstract

Background Early-life respiratory tract infections could affect airway obstruction and increase asthma risk in later life. However, results from previous studies are inconsistent.

Objective We examined the associations of early-life respiratory tract infections with lung function and asthma in school-aged children.

Methods This study among 5197 children born between April 2002 and January 2006 was embedded in a population-based prospective cohort study. Information on physician-attended upper and lower respiratory tract infections until age 6 years (categorised into ≤3 and >3–6 years) was obtained by annual questionnaires. Spirometry measures and physician-diagnosed asthma were assessed at age 10 years.

Results Upper respiratory tract infections were not associated with adverse respiratory outcomes. Compared with children without lower respiratory tract infections ≤3 years, children with lower respiratory tract infections ≤3 years had a lower FEV1, FVC, FEV1:FVC and forced expiratory flow at 75% of FVC (FEF75) (Z-score (95% CI): ranging from −0.22 (−0.31 to –0.12) to −0.12 (−0.21 to −0.03)) and an increased risk of asthma (OR (95% CI): 1.79 (1.19 to 2.59)). Children with lower respiratory tract infections >3–6 years had an increased risk of asthma (3.53 (2.37 to 5.17)) only. Results were not mediated by antibiotic or paracetamol use and not modified by inhalant allergic sensitisation. Cross-lagged modelling showed that results were not bidirectional and independent of preschool wheezing patterns.

Conclusion Early-life lower respiratory tract infections ≤3 years are most consistently associated with lower lung function and increased risk of asthma in school-aged children.

  • respiratory infection
  • asthma
  • clinical epidemiology

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Footnotes

  • Contributors ERvM, HTdD and LD contributed to the conception and design, acquisition of data and analyses and interpretation of the data, drafted the article, revised it critically for important intellectual content and gave final approval of the version to be published. NJE, PWJ, HAM, IR, JCdJ and VJ contributed to the conception and design and acquisition of data, revised the drafted manuscript critically for important intellectual content and gave final approval of the version to be published.

  • Funding The Generation R Study is made possible by financial support from the Erasmus Medical Centre, Rotterdam, the Erasmus University Rotterdam, the Netherlands Organization for Health Research and Development and the Ministry of Health, Welfare and Sport. PWJ received a grant from the Dutch Diabetes Foundation (grant no. 2013.81.1664). VJ received grants from the Netherlands Organization for Health Research and Development (VIDI o16.136.3610) and the European Research Council (ERC-2014-CoG-648916). LD received funding from the Lung Foundation Netherlands (no. 3.2.12.089; 2012). The project received funding from the European Union’s Horizon 2020 research and innovation programme (LIFECYCLE project, grant agreement no. 733206; 2016) and from cofunded ERA-Net on Biomarkers for Nutrition and Health (ERA HDHL), Horizon 2020 (grant agreement no. 696295; 2017), ZonMW The Netherlands (no. 529051014; 2017), Science Foundation Ireland (no. SFI/16/ERA-HDHL/3360) and the European Union (ALPHABET project). The researchers are independent from the funders. The study sponsors had no role in the study design, data analysis, interpretation of data or writing of this report.

  • Competing interests None declared.

  • Ethics approval Medical ethical committee of the Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands (MEC-2012–165).

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

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