JOURNAL ARTICLE

Wheezing rhinovirus illnesses in early life predict asthma development in high-risk children

Daniel J Jackson, Ronald E Gangnon, Michael D Evans, Kathy A Roberg, Elizabeth L Anderson, Tressa E Pappas, Magnolia C Printz, Wai-Ming Lee, Peter A Shult, Erik Reisdorf, Kirsten T Carlson-Dakes, Lisa P Salazar, Douglas F DaSilva, Christopher J Tisler, James E Gern, Robert F Lemanske
American Journal of Respiratory and Critical Care Medicine 2008 October 1, 178 (7): 667-72
18565953

RATIONALE: Virus-induced wheezing episodes in infancy often precede the development of asthma. Whether infections with specific viral pathogens confer differential future asthma risk is incompletely understood.

OBJECTIVES: To define the relationship between specific viral illnesses and early childhood asthma development.

METHODS: A total of 259 children were followed prospectively from birth to 6 years of age. The etiology and timing of specific viral wheezing respiratory illnesses during early childhood were assessed using nasal lavage, culture, and multiplex reverse transcriptase-polymerase chain reaction. The relationships of these virus-specific wheezing illnesses and other risk factors to the development of asthma were analyzed.

MEASUREMENTS AND MAIN RESULTS: Viral etiologies were identified in 90% of wheezing illnesses. From birth to age 3 years, wheezing with respiratory syncytial virus (RSV) (odds ratio [OR], 2.6), rhinovirus (RV) (OR, 9.8), or both RV and RSV (OR , 10) was associated with increased asthma risk at age 6 years. In Year 1, both RV wheezing (OR, 2.8) and aeroallergen sensitization (OR, 3.6) independently increased asthma risk at age 6 years. By age 3 years, wheezing with RV (OR, 25.6) was more strongly associated with asthma at age 6 years than aeroallergen sensitization (OR, 3.4). Nearly 90% (26 of 30) of children who wheezed with RV in Year 3 had asthma at 6 years of age.

CONCLUSIONS: Among outpatient viral wheezing illnesses in infancy and early childhood, those caused by RV infections are the most significant predictors of the subsequent development of asthma at age 6 years in a high-risk birth cohort.

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