Asthma and allergy patterns over 18 years after severe RSV bronchiolitis in the first year of life

Abstract

Background An increased prevalence of asthma/ recurrent wheeze (RW), clinical allergy and allergic sensitisation up to age 13 years has previously been reported in subjects hospitalised with respiratory syncytial virus (RSV) bronchiolitis in their first year of life compared with matched controls. A study was undertaken to examine whether these features persist into early adulthood, to report longitudinal wheeze and allergy patterns, and to see how large and small airway function relates to RSV infection and asthma. Methods Follow-up at age 18 years was performed in 46 of 47 subjects with RSV and 92 of 93 controls. Assessments included questionnaire, clinical examination, skin prick tests, serum IgE antibodies to inhaled allergens, blood eosinophils, fraction of exhaled nitric oxide (FeNO), spirometry, multiple breath washout (lung clearance index, LCI) and dry air hyperventilation challenge. Results Increased prevalence of asthma/RW (39% vs 9%), clinical allergy (43% vs 17%) and sensitisation to perennial allergens (41% vs 14%) were present at age 18 in the RSV cohort compared with controls. Persistent/ relapsing wheeze associated with early allergic sensitisation predominated in the RSV cohort compared with controls (30% vs 1%). Spirometric function was reduced in subjects with RSV with or without current asthma, but not in asthmatic controls. LCI was linked only to current asthma, airway hyperresponsiveness and FeNO. Conclusions Severe early RSV bronchiolitis is associated with an increased prevalence of allergic asthma persisting into early adulthood. Small airway dysfunction (LCI) is related to current asthma and airway inflammation but not to RSV bronchiolitis. Reduced spirometry after RSV may reflect airway remodelling.

Ventilation Heterogeneity and Airway Hyperreactivity in Children with Well Controlled Asthma

“…Our finding in pre-school and school age children is consistent with other studies of older children and adults with well controlled asthma [9]. However, this study is one of the first using nitrogen (N 2 ) as an inert gas in this age group, while previous studies [9][10][11][12] used different gases such as sulfur hexafluoride (SF 6 ). Given that SF 6 is difficult to obtain in the United States, a better understanding of the sensitivity of measurements of MBW using N 2 as the inert gas is important.…”

“…Among adult asthmatics, greater ventilation heterogeneity is associated with increased airway reactivity [8]. Limited studies have been conducted in children with asthma evaluating ventilation heterogeneity using differing inert gases (sulfur hexafluoride, SF 6 ; and nitrogen, N 2 ) and methodology [9][10][11][12]. No studies have specifically evaluated the association of ventilation heterogeneity with airway hyper-responsiveness in children with asthma.…”

Le microbiome pulmonaire en 2015

“…Il évoluera dans le temps en fonction de la pathologie mais, quelle qu'elle ronnement dans lequel les enfants grandissent (milieu rural versus milieu urbain), sa contamination bactérienne et fongique, et le risque de développer une atopie ou un asthme [38,39]. Par ailleurs, les infections virales, notamment les bronchiolites de l'enfance et en particulier celles à rhinovirus, semblent être impliquées dans la genèse de l'asthme, peut-être sur des terrains prédisposés [40][41][42]. Aujourd'hui, de nombreuses données tendent à montrer que plus le microbiote environnemental est diversifié, moins le risque de développer un asthme est important.…”

Ficus religiosa L. bark extracts inhibit human rhinovirus and respiratory syncytial virus infection in vitro

“…According to molecular diagnostics, most of the wheezing episodes occurring during the first five years of life are associated with viral infections (Jackson et al, 2008), with respiratory syncytial virus (RSV), human rhinovirus (HRV), and human metapneumovirus (Jartti et al, 2004;Calvo et al, 2007;Garcia-Garcia et al, 2007;Fujitsuka et al, 2011) being the most common viruses identified during early-life wheezing illnesses. Data gathered so far demonstrate that both RSV and HRV represent an important risk factor associated with wheezing illness and subsequent increased risk of asthma development (Sigurs et al, 2010;Jackson et al, 2012) RSV is the major cause of LRT infections (LRTIs) in the first months of life. Epidemiological studies have clearly demonstrated that severe RSV bronchiolitis is frequently associated with subsequent persistent wheezing, childhood asthma or both (Stein et al, 1999;Gern and Busse, 2002;Henderson et al, 2005;Koponen et al, 2012).…”