Hospitalization for respiratory syncytial virus (RSV) may be associated with significantly higher rates and severity of asthma during childhood, according to study results published in Pediatric Pulmonology.

Growing evidence suggests that children younger than 3 years of age with RSV lower respiratory tract infection (LRTI) may be at risk of experiencing long-term respiratory morbidity, particularly wheezing and asthma; however, the evidence associating RSV LRTI with long-term asthma is ambiguous, with some studies suggesting no clear evidence and other studies suggesting a significantly increased risk. The objective of this study was to determine whether severe RSV LRTI in children aged 2 years and younger is associated with increased rates of asthma and whether associated asthma persists through childhood up to age 18 years.

In this study, researchers assessed data on all live births that occurred in National Health Service Scotland hospitals from 1996 to 2011 and followed these children until 18 years of age or the end of the study period in 2014, whichever came first. Children included in the study were split into 2 cohorts: children hospitalized for RSV during their first 2 years of life (cases) and children who were not hospitalized for RSV (control participants).

 Demographic factors assessed in all children included sex, birth weight, and diagnosis of a comorbidity associated with an increased risk for RSV hospitalization, as well as the mother’s age at birth, smoking history, and socioeconomic status. The primary outcomes were asthma admissions and the use of asthma medications through age 18 years.


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Results revealed that of the 740,418 children assessed in this study, 15,795 (2.1%) were hospitalized for RSV within the first 2 years of life (median age at first hospitalization: 143 (interquartile range [IQR], 64-274) days. The rate of hospitalizations for asthma was significantly higher in the hospitalized cohort than in the control group (8.4% vs 2.4%; relative risk [RR], 3.3 [95% CI, 3.1-3.5]; P <.0001). The asthma admission rate was also higher (193.2/1000 vs 46.0/1000). Nearly 2 times as many hospitalized children received 1 or more asthma medications during childhood than control participants (25.5% vs 14.7%; RR, 1.7 [95% CI, 1.7-1.8]; P <.0001), and the incidence of confirmed asthma was significantly higher in this group than in control participants (4.8% vs 1.5%; RR, 3.1 [95% CI, 2.9-3.3; P <.0001). The most significant risk factor for asthma hospitalization was a history of RSV hospitalization (odds ratio [OR], 2.80 [95% CI, 2.60-3.02]; P <.001).

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The main limitations of this study included reliance on available datasets and coding accuracy and difficulties with confirming asthma diagnosis.

The study researchers concluded that a significant link exists between severe RSV LRTI and persistent asthma in young children, demonstrated by increased rates of asthma hospitalizations and the prescribing of asthma medications among children hospitalized for RSV.

Disclosure: This clinical trial was supported by AbbVie Inc.. Please see the original reference for a full list of authors’ disclosures.

Reference

Coutts J, Fullarton J, Morris C, et al. Association between respiratory syncytial virus hospitalization in infancy and childhood asthma [published online February 10, 2020]. Pediatr Pulmonol. doi:10.1002/ppul.24676