Published ahead of print on June 19, 2008, doi:10.1164/rccm.200802-309OC
Am. J. Respir. Crit. Care Med., Volume 178, Number 7, October 2008, 667-672
A more recent version of this article appeared on October 1, 2008
Submitted on February 21, 2008
Accepted on June 19, 2008
Wheezing Rhinovirus Illnesses in Early Life Predict Asthma Development in High Risk Children
Daniel J Jackson1*, Ronald E Gangnon2, Michael D Evans3, Kathy A Roberg4, Elizabeth L Anderson4, Tressa E Pappas4, Magnolia C Printz4, Wai-Ming Lee4, Peter A Shult5, Erik Reisdorf5, Kirsten T Carlson-Dakes4, Lisa P Salazar4, Douglas F DaSilva4, Christopher J Tisler4, James E Gern4, and Robert F Lemanske Jr.1
1 Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA; Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA,
2 Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA; Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA,
3 Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA,
4 Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA,
5 University of Wisconsin-Madison, the Wisconsin State Laboratory of Hygiene, Madison, WI, USA
* To whom correspondence should be addressed. 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: 259 children were followed prospectively from birth to six years of age. The etiology and timing of specific viral wheezing respiratory illnesses during early childhood were assessed using nasal lavage, culture and multiplex RT-PCR. 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 three years, wheezing with RSV (OR=2.6), rhinovirus (RV) (OR=9.8), or both RV and RSV (OR=10) was associated with increased asthma risk at age six years. In year one, both RV wheezing (OR = 2.8) and aeroallergen sensitization (OR = 3.6) independently increased asthma risk at age six years. By age three years, wheezing with RV (OR = 25.6) was more strongly associated with asthma at age six years than aeroallergen sensitization (OR = 3.4). Nearly 90% (26 of 30) of children who wheezed with RV in year three had asthma at six 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 six years in a high-risk birth cohort.
Key words: rhinovirus, respiratory syncytial virus, wheezing, asthma, allergic sensitization
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