Asthma risk after a pediatric intensive care unit admission for respiratory syncytial virus bronchiolitis

Abstract

Background: Admission to a pediatric intensive care unit (PICU) has been associated with respiratory consequences in children with asthma and carries major implications for management control. Whereas respiratory syncytial virus (RSV) bronchiolitis has been associated with increasing intensity of wheezing, the relationship between RSV-bronchiolitis PICU admission and future asthma is unclear. This retrospective case-control study evaluated whether hospitalization in the PICU due to RSV bronchiolitis is more likely to be associated with future asthma in early life compared with hospitalization in a general pediatric ward. Methods: Children hospitalized due to RSV bronchiolitis between 2007 and 2019 in the PICU (study group) were compared to those hospitalized in a general pediatric ward (controls). Asthma prevalence was assessed by a follow-up questionnaire based on The International Study of Asthma and Allergies in Childhood questionnaire. Results: Sixty-three PICU patients and 66 controls were included. The PICU patients presented with more severe disease during RSV hospitalization. At follow-up, significantly more PICU patients aged 3-6 years had physician-diagnosed asthma, respiratory symptoms during the previous 12 months, and underwent respiratory treatment since hospital discharge compared to controls (14 [60.9%] vs. 4 [18.2%] patients; 15 [65.2%] vs. 6 [27.3%]; and 16 [69.6%] vs. 8 [36.4%]; respectively). These differences were no longer observed after 6 years of age.Conclusions: Children admitted to the PICU for RSV bronchiolitis are at higher risk for asthma in subsequent pre-school years and will require close respiratory followup than those admitted to general pediatric wards. Admission venue should be queried when asthma is suspected.

Pediatric pulmonology 2022 year in review: Asthma

“…Based on parent interviews 3-10 years later, the authors found that children between the ages of 3 and 6 who were admitted to the PICU with RSV had a significantly higher rate of asthma diagnosis. 9 However after the age of 6, there was no significant difference between the two groups. Based on these findings, physicians may be able to use PICU admission for RSV bronchiolitis as a predictor of future risk for childhood asthma.…”

“…Sixty‐three patients with RSV who were admitted to the PICU were compared to 66 control patients with RSV who were admitted to the hospital ward. Based on parent interviews 3–10 years later, the authors found that children between the ages of 3 and 6 who were admitted to the PICU with RSV had a significantly higher rate of asthma diagnosis 9 . However after the age of 6, there was no significant difference between the two groups.…”