Decreased lung function precedes severe respiratory syncytial virus infection and post-respiratory syncytial virus wheeze in term infants

Abstract

It is unknown why respiratory syncytial virus (RSV) causes mild disease in some children and severe disease, requiring hospitalisation, in others. We aimed to assess whether diminished premorbid lung function in healthy term infants predisposes to hospitalisation during RSV bronchiolitis, and to post-RSV wheeze.In a prospective birth cohort study of unselected term healthy children, neonatal lung function was measured before the age of 2 months (n52133). From birth through the first year of life, respiratory symptoms were recorded in a diary, and general practitioner consultations and hospitalisations were documented. In a subgroup (n5417) repeated nose and throat swabs were collected for PCR to detect RSV infections.Median neonatal respiratory system compliance (Crs) was significantly lower (41.2 versus 47.4 mL?kPa -1 , p50.03) and resistance (Rrs) was higher (8.2 versus 6.3 kPa?s?L -1 , p50.10) in hospitalised RSV patients (n518) compared with nonhospitalised RSV-positive infants (n584). Every 10 mL?kPa -1 increase in Crs was associated with 55% less post-RSV wheeze (OR 0.56, 95% CI 0.35-0.90), and each kPa?s?L -1 increase in Rrs was associated with 42% more post-RSV wheeze, which was only marginally explained by pre-RSV wheeze or severity of the RSV disease.This unselected birth cohort study shows for the first time that decreased lung function at birth predisposes to severe RSV disease, and to post-RSV wheeze. @ERSpublications Impaired neonatal lung function precedes a severe course of RSV infection in unselected children

The Burden and Long-term Respiratory Morbidity Associated with Respiratory Syncytial Virus Infection in Early Childhood

“…The MAKI trial has strongly implicated RSV infection as an important mechanism of recurrent wheeze during the first year of life in such infants [66]. A further study from the same group proposed that lower lung function in school-aged children that were previously hospitalized for RSV LRTI cannot only be attributed to the RSV infection itself, but might be partially pre-existent [67]. …”

Prospective study confirms that bronchiolitis in early infancy increases the risk of reduced lung function at 10–13 years of age

“…A prospective birth cohort study from the Netherlands evaluated lung function using a single occlusion technique in 2.133 healthy term infants before two months of age . The researchers found that respiratory system compliance was lower in those 18 infants who were hospitalised for RSV bronchiolitis before 12 months of age, compared to 84 nonhospitalised RSV positive children . In the present study, the lung function of former bronchiolitis patients was evaluated with impulse oscillometry at five to seven years of age and with one exception, the lung function reductions, although present in 20%, were reversible .…”

“…How often and at what age irreversible lung function reduction after bronchiolitis develops is not known. A prospective birth cohort study from the Netherlands evaluated lung function using a single occlusion technique in 2.133 healthy term infants before two months of age . The researchers found that respiratory system compliance was lower in those 18 infants who were hospitalised for RSV bronchiolitis before 12 months of age, compared to 84 nonhospitalised RSV positive children .…”

The role of respiratory tract infections and the microbiome in the development of asthma: A narrative review

“…However, some studies that measured early‐life lung function suggest the opposite direction of causality. One prospective cohort study showed that increased bronchial responsiveness in infancy was associated with increased risk of severe bronchiolitis and another showed that children with a lower respiratory system compliance, and higher resistance at the age of 2 months, were at greater risk for hospitalization for an RSV infection and wheeze after the infection . However, the latter study group demonstrated that the association of HRV in the first year of life with wheezing at the age of 4 years remained significant after adjusting for lung function measurements at the age of 2 months .…”