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Published ahead of print on June 19, 2008, doi:10.1164/rccm.200802-309OC
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American Journal of Respiratory and Critical Care Medicine Vol 178. pp. 667-672, (2008)
© 2008 American Thoracic Society
doi: 10.1164/rccm.200802-309OC

Original Article

Wheezing Rhinovirus Illnesses in Early Life Predict Asthma Development in High-Risk Children

Daniel J. Jackson1,2, Ronald E. Gangnon3,4, Michael D. Evans3, Kathy A. Roberg1, Elizabeth L. Anderson1, Tressa E. Pappas1, Magnolia C. Printz1, Wai-Ming Lee1, Peter A. Shult5, Erik Reisdorf5, Kirsten T. Carlson-Dakes1, Lisa P. Salazar1, Douglas F. DaSilva1, Christopher J. Tisler1, James E. Gern1 and Robert F. Lemanske, Jr.1,2

Departments of 1 Pediatrics, 2 Medicine, 3 Biostatistics and Medical Informatics, and 4 Population Health Sciences, University of Wisconsin–Madison; and the 5 Wisconsin State Laboratory of Hygiene, Madison, Wisconsin

Correspondence and requests for reprints should be addressed to Daniel J. Jackson, M.D., University of Wisconsin Hospital, 600 Highland Avenue, K4/910, Madison, WI 53792. E-mail: djj{at}medicine.wisc.edu

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.

Key Words: rhinovirus • respiratory syncytial virus • wheezing • asthma • allergic sensitization


AT A GLANCE COMMENTARY

Scientific Knowledge on the Subject
Viral respiratory wheezing illnesses are common in early childhood, and many children who wheeze subsequently develop asthma. However, the impact on asthma risk of the specific viral etiology of these illnesses is not known.

What This Study Adds to the Field
Early rhinovirus wheezing illnesses are the most robust predictor of subsequent asthma development in high-risk children.

 



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