The severity-dependent relationship of infant bronchiolitis on the risk and morbidity of early childhood asthma

doi:10.1016/j.jaci.2009.02.021

Journal of Allergy and Clinical Immunology

Volume 123, Issue 5, May 2009, Pages 1055-1061.e1

https://doi.org/10.1016/j.jaci.2009.02.021 Get rights and content

Background

Infants hospitalized for bronchiolitis have a high rate of early childhood asthma. It is not known whether bronchiolitis severity correlates with the risk of early childhood asthma or with asthma-specific morbidity.

Objectives

We sought to determine whether a dose-response relationship exists between severity of infant bronchiolitis and both the odds of early childhood asthma and asthma-specific morbidity.

Methods

We conducted a population-based retrospective birth cohort study of term healthy infants born from 1995-2000 and enrolled in a statewide Medicaid program. We defined bronchiolitis severity by categorizing infants into mutually exclusive groups based on the most advanced level of health care for bronchiolitis. Health care visits, asthma-specific medications, and demographics were identified entirely from Medicaid and linked vital records files. Asthma was ascertained at between 4 and 5.5 years of age, and 1-year asthma morbidity (hospitalization, emergency department visit, or oral corticosteroid course) was determined between 4.5 and 5.5 years among children with prevalent asthma.

Results

Among 90,341 children, 18% had an infant bronchiolitis visit, and these infants contributed to 31% of early childhood asthma diagnoses. Relative to children with no infant bronchiolitis visit, the adjusted odds ratios for asthma were 1.86 (95% CI, 1.74-1.99), 2.41 (95% CI, 2.21-2.62), and 2.82 (95% CI, 2.61-3.03) in the outpatient, emergency department, and hospitalization groups, respectively. Children hospitalized with bronchiolitis during infancy had increased early childhood asthma morbidity compared with that seen in children with no bronchiolitis visit.

Conclusion

To our knowledge, this is the first study to demonstrate the dose-response relationship between the severity of infant bronchiolitis and the increased odds of both early childhood asthma and asthma-specific morbidity.

Section snippets

Study design and population

To estimate the association of bronchiolitis during infancy with the development of early childhood asthma, we conducted a population-based retrospective birth cohort study of more than 90,000 term, non–low birth weight infants enrolled in TennCare within the first month of life (1995-2000, the TABS). Only children born between 1995 and 2000 were included because all children were followed to 5.5 years by using the years for which data were available. In 1994, TennCare replaced the federal

Results

A total of 90,341 term healthy children were included in the cohort. Forty-nine percent of the children were girls; the children were white (56%), black (39%), and Hispanic (2%; Table I). The median EGA was 40 weeks, and the median birth weight was 3289 g. Overall, 26% of children had mothers who smoked during pregnancy. Eighteen percent of children had at least 1 health care visit for bronchiolitis during infancy, and children were classified into the following groups: no visit (82%),

Discussion

Although the association of viral lower respiratory tract infection during infancy and subsequent childhood wheezing is well established, this study addresses important gaps in our knowledge regarding the relationship of bronchiolitis severity on early childhood asthma risk and asthma morbidity. To our knowledge, this is the first study to demonstrate the dose-response relationship between the severity of infant bronchiolitis and the increased odds of both early childhood asthma and increased

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: Supported in part by NIH U01 HL 072471 (T.V.H.), the Thrasher Research Fund (T.V.H.), NIH KO1 AI070808 (K.N.C.), NIH K24 AI 077930 (T.V.H.), NIH F32 HL 086048 (P.W., T.V.H.), and the Parker B. Francis Research Foundation (K.N.C.).

: Disclosure of potential conflict of interest: K. N. Carroll has received research support from the National Institutes of Health/National Institute of Allergy and Infectious Diseases and the Parker B. Francis Foundation. P. Wu has received research support from the National Institutes of Health and the Thrasher Research Fund. T. Gebretsadik has received research support from the National Institutes of Health/National Institute of Allergy and Infectious Diseases. M. R. Griffin has received research support from MedImmune, Pfizer, the Center for Disease Control and Prevention, and the Agency for Healthcare Research and Quality. T. V. Hartert has served as a speaker for and on the Advisory Board for Merck and has received research support from the National Institutes of Health and the Thrasher Research Fund. The rest of the authors have declared that they have no conflict of interest.

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Reviews and feature articleThe severity-dependent relationship of infant bronchiolitis on the risk and morbidity of early childhood asthma

Background

Objectives

Methods

Results

Conclusion

Section snippets

Study design and population

Results

Discussion

J Allergy Clin Immunol

J Allergy Clin Immunol

Lancet

J Allergy Clin Immunol

J Allergy Clin Immunol

Am J Obstet Gynecol

Ann Epidemiol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Pediatr

J Allergy Clin Immunol

J Allergy Clin Immunol

National surveillance for asthma—United States, 1980-2004

MMWR Surveill Summ

Asthma and wheezing in the first six years of life. The Group Health Medical Associates

N Engl J Med

Risk of primary infection and reinfection with respiratory syncytial virus

Am J Dis Child

The Tucson Children's Respiratory Study. II. Lower respiratory tract illness in the first year of life

Am J Epidemiol

Bronchiolitis-associated hospitalizations among US children, 1980-1996

JAMA

Respiratory status and allergy nine to 10 years after acute bronchiolitis

Arch Dis Child

Severe respiratory syncytial virus bronchiolitis in infancy and asthma and allergy at age 13

Am J Respir Crit Care Med

Respiratory syncytial virus bronchiolitis in infancy is an important risk factor for asthma and allergy at age 7

Am J Respir Crit Care Med

Respiratory status and allergy after bronchiolitis

Arch Dis Child

Reviews and feature article
The severity-dependent relationship of infant bronchiolitis on the risk and morbidity of early childhood asthma