Could Antioxidants Prevent Wheezing in Infants Following Viral ARIs?

Oxidative stress following viral acute respiratory infections (ARIs) in the first year of life, may increase the development of recurrent wheezing in early childhood, according to research presented at the American Thoracic Society (ATS) 2017 International Conference, held May 19-24 in Washington, DC.¹

Christian Rosas-Salazar, MD, MPH, from the Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tennessee, and colleagues used data from the National Institutes of Health-funded INSPIRE (Infant Susceptibility to Pulmonary Infections and Asthma Following RSV Exposure) study to examine urine F2-isoprostane concentrations, a marker of oxidative stress, from 476 infants at enrollment near birth and/or during a viral ARI.

The median interquartile range (IQR) age of infants at enrollment was 29 (14 to 66) days and 145 (90 to 190) days during a viral ARI. Outcome was recurrent wheezing in children at 2 years of age, defined by ≥3 wheezing episodes by parental report since the infant’s prior birthday.

Of the 430 infants included in the analyses, 13.5% (58) developed recurrent wheezing. The association between urine F2-isoprostane concentrations and recurrent wheezing was not significant in infants when they were first enrolled in the study. However, urine F2-isoprostane concentrations during a viral ARI were significantly higher in infants who developed recurrent wheezing compared with infants who did not (median interquartile range [IQR] 6.9 [3.6-12.9] vs 4.7 [3.0-7.3], P =.004).

In a multivariable analysis, after adjusting for age at the time of illness, sex, maternal asthma, ARI severity, and household smoking, this association persisted. The odds of recurrent wheezing increased approximately 2-fold (OR [odds ratio] 1.9; 95% CI 1.1-3.1, P =.01) with an interquartile difference of 4.6 ng/mg of creatinine of urine F2-isoprostane.

Findings from this study suggests that urine F2-isoprostane concentrations during viral ARI in infancy may be a biomarker for the development of recurrent wheezing. Thus, antioxidants “could be an effective wheezing prevention strategy following infant viral ARIs; however, research would first need to be done to determine the effects, adequate dosing and safety of certain antioxidant agents in infants before they can be recommended for this use,” concluded Dr Rosas-Salazar in a press release.²

1. Rosas-Salazar C, Gebretsadik T, Milne GL, et al. The role of oxidative stress in the pathogenesis of recurrent wheeze in children following infant viral respiratory illnesses. Presented at: ATS 2017 International Conference; Washington, DC; May 19-24. Abstract 9185.
2. Viral acute respiratory infections in infants may lead to recurrent childhood wheezing through inducing oxidative stress [press release]. New York, NY: American Thoracic Society. http://www.thoracic.org/about/newsroom/press-releases/conference/2017/rosas-salazar-childhood-wheezing.php Published May 22, 2017. Accessed May 23, 2017.