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Exploring the Association between Severe Respiratory Syncytial Virus Infection and Asthma

A Registry-based Twin Study

¹ Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark; ² Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands; ³ Danish Epidemiology Science Centre, Statens Serum Institut, Copenhagen, Denmark; ⁴ The Danish Twin Registry, University of Southern Denmark, Odense, Denmark; ⁵ Institute of Regional Health Research Services, University of Southern Denmark, Odense, Denmark; ⁶ Queensland Institute of Medical Research, Brisbane, Australia; and ⁷ Danish Pediatric Asthma Center, University Hospital of Copenhagen, Gentofte, Denmark

Correspondence and requests for reprints should be addressed to Simon Francis Thomsen, M.D., Ph.D., Department of Respiratory Medicine, Bispebjerg Hospital, DK-2400 Copenhagen NV, Denmark. E-mail: sft{at}city.dk

Rationale: Severe respiratory syncytial virus (RSV) infection is associated with asthma but the nature of this association is imperfectly understood.

Objectives: To examine the nature of the association between severe RSV infection and asthma in a population-based sample of twins.

Methods: Data on hospitalization due to RSV infection was gathered for all twins born in Denmark between 1994 and 2000 (8,280 pairs) and linked to information on asthma obtained from hospital discharge registries and parent-completed questionnaires. Genetic variance components models and direction of causation models were fitted to the observed data.

Measurements and Main Results: RSV hospitalization and asthma were positively associated (r = 0.43), and genetic determinants for the two disorders overlapped completely. Modeling the direction of causation between RSV hospitalization and asthma showed that a model in which asthma "causes" RSV hospitalization fitted the data significantly better (P = 0.39 for deterioration in model fit) than a model in which RSV hospitalization "causes" asthma (P < 0.001 for deterioration in model fit), even when sex, birth weight, and maternal smoking during pregnancy were accounted for.

Conclusions: RSV infection that is severe enough to warrant hospitalization does not cause asthma but is an indicator of the genetic predisposition to asthma.

Key Words: RSV infection • asthma • twin study • genetic • direction of causation

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Severe respiratory syncytial virus (RSV) infection is associated with asthma development. However, the nature of this relationship is imperfectly understood. What This Study Adds to the Field RSV infection that is severe enough to warrant hospitalization does not appear to cause asthma but is an indicator of the genetic predisposition to asthma.

 

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