Published ahead of print on September 5, 2008, doi:10.1164/rccm.200804-579OC Am. J. Respir. Crit. Care Med., Volume 178, Number 11, December 2008, 1123-1129 A more recent version of this article appeared on December 1, 2008
Submitted on April 17, 2008 Evidence of a Causal Role of Winter Virus Infection During Infancy on Early Childhood AsthmaPingsheng Wu1,1 Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States; Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States, 2 Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States; Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States, 3 Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States; Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, Tennessee, United States; Institute for Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, Tennessee, United States, 4 Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States, 5 Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States, 6 Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States, 7 Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States; Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States; Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, Tennessee, United States * To whom correspondence should be addressed. E-mail: tina.hartert{at}vanderbilt.edu.
Rationale: Bronchiolitis during infancy is associated with an increased risk of childhood asthma. Whether winter viral infections cause asthma, or are a manifestation of a predisposition to asthma development, is unknown. Objectives: To study the relationship of winter virus infection during infancy and the development of childhood asthma. Methods: We studied over 95,000 infants born between 1995-2000 and followed through 2005, who were enrolled in the Tennessee Medicaid program from birth through early childhood to determine whether infant birth in relationship to the winter virus peak alters the risk of developing early childhood asthma. Measurements and Main Results: Among 95,310 children studied during five winter virus seasons from birth through early childhood, the risk of developing asthma tracked with the timing of infant birth in relationship to the winter virus peak. Infant birth approximately four months prior to the winter virus peak carried the highest risk, with a 29% increase in odds of developing asthma compared with birth 12 months prior to the peak [Adjusted Odds Ratio: 1.29, 95% Confidence interval: 1.19-1.40]. Infant age at the winter virus peak was comparable to or greater than other known risk factors for asthma. Conclusions: Timing of birth in relationship to winter virus season confers a differential and definable risk of developing early childhood asthma, establishing winter virus seasonality as a causal factor in asthma development. Delay of initial exposure or prevention of winter viral infection during early infancy could prevent asthma. Key words: asthma • respiratory winter virus infection • timing of birth
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