Increased Risk of Asthma following Hospitalization for Respiratory Syncytial Virus Infection in the First Two Years of Life

Introduction: Respiratory syncytial virus (RSV) infection is one of the leading causes of RSV hospitalization in early childhood. There is increasing evidence to suggest that RSVH is associated with subsequent development of recurrent wheeze and, possibly, asthma. The aim of this study was to provide more data on the link between RSVH and asthma.

Materials and Methods: Datasets collated by the Information Services Division (ISD) of the NHS National Services Scotland were utilized. All live births from 1996 to 2011 were identified and divided into two cohorts based on the presence or absence of RSVH during the first 2 years of life. Information on hospital admissions for asthma and antiasthma drug prescriptions during childhood (≤17 years) was captured. Time-to-event analyses (Kaplan–Meier and Cox’s regression) were undertaken.

Results: In total, 740,417 live births were identified: 41,868 (5.7%) in the RSV cohort and 698,549 in the non-RSV cohort. Gestational age (median 39 [interquartile range, IQR, 38–40] vs. 40 [39–41] weeks) and birth weight (median 3.3 [2.9–3.7] vs. 3.4 [3.1–3.8] kg) were lower in the RSV cohort than in the non-RSV cohort, while frequency of maternal smoking was higher (30.8 vs. 23.2%). In the RSV cohort, 12.2% of the children (5,089 out of 41,868) had at least one asthma hospitalization during childhood compared with 2.0% (13,992 out of 698,549) of the non-RSV cohort (p  <  0.001). The rate of asthma hospitalization was 6.6 times higher in the RSV cohort. In addition, children in the RSV cohort had their first hospitalization for asthma at an earlier age (mean 861 vs. 948 days for non-RSV; p  <  0.001). Throughout childhood, the rate of asthma admission was higher in the RSV cohort (peak: 46.2 out of 1,000 at 2–3 years) than in the non-RSV cohort (4.8/1,000 at 4–5 years) ([Fig. 1]). Approximately twice as many children in the RSV cohort than in the non-RSV cohort had received prescriptions for antiasthma drugs (RSV: 29.0 vs. non-RSV: 14.1%).

Conclusion: These results demonstrate a strong association between RSVH and subsequent asthma development, which persists throughout childhood.

Keywords: respiratory syncytial virus, bronchiolitis, lower respiratory tract infection, asthma, hospitalization, long-term morbidity

Fig. 1 Asthma admission rates.

 

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No conflict of interest has been declared by the author(s).