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Wheezing Rhinovirus Illnesses in Early Life Predict Asthma Development in High Risk Children.

Am J Respir Crit Care Med. 2008 Jun 19 Jackson DJ, Gangnon RE, Evans MD, Roberg KA, Anderson EL, Pappas TE, Printz MC, Lee WM, Shult PA, Reisdorf E, Carlson-Dakes KT, Salazar LP, Dasilva DF, Tisler CJ, Gern JE, Lemanske Jr RF. Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA; Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.

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.

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