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. 2011 Sep;128(3):532-8.e1-10.
doi: 10.1016/j.jaci.2011.06.037.

Decreased lung function after preschool wheezing rhinovirus illnesses in children at risk to develop asthma

Theresa W Guilbert  1 , Anne Marie Singh, Zoran Danov, Michael D Evans, Daniel J Jackson, Ryan Burton, Kathy A Roberg, Elizabeth L Anderson, Tressa E Pappas, Ronald Gangnon, James E Gern, Robert F Lemanske Jr
Affiliations

Decreased lung function after preschool wheezing rhinovirus illnesses in children at risk to develop asthma

Theresa W Guilbert et al. J Allergy Clin Immunol. 2011 Sep.

Abstract

Background: Preschool rhinovirus (RV) wheezing illnesses predict an increased risk of childhood asthma; however, it is not clear how specific viral illnesses in early life relate to lung function later on in childhood.

Objective: To determine the relationship of virus-specific wheezing illnesses and lung function in a longitudinal cohort of children at risk for asthma.

Methods: Two hundred thirty-eight children were followed prospectively from birth to 8 years of age. Early life viral wheezing respiratory illnesses were assessed by using standard techniques, and lung function was assessed annually by using spirometry and impulse oscillometry. The relationships of these virus-specific wheezing illnesses and lung function were assessed by using mixed-effect linear regression.

Results: Children with RV wheezing illness demonstrated significantly decreased spirometry values, FEV(1) (P = .001), FEV(0.5) (P < .001), FEF(25-75) (P < .001), and also had abnormal impulse oscillometry measures--more negative reactance at 5 Hz (P < .001)--compared with those who did not wheeze with RV. Children who wheezed with respiratory syncytial virus or other viral illnesses did not have any significant differences in spirometric or impulse oscillometry indices when compared with children who did not. Children diagnosed with asthma at ages 6 or 8 years had significantly decreased FEF(25-75) (P = .05) compared with children without asthma.

Conclusion: Among outpatient viral wheezing illnesses in early childhood, those caused by RV infections are the most significant predictors of decreased lung function up to age 8 years in a high-risk birth cohort. Whether low lung function is a cause and/or effect of RV wheezing illnesses is yet to be determined.

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Figures

Fig 1
Fig 1
Percentage of children who met acceptability criteria for spirometry (light blue) or IOS (dark blue) by age group. At 4 years of age, 21% of children who attempted IOS had acceptable tests compared with 24% with successful spirometry (P = .7). For ages 5, 6, 7, and 8 years, percentages of acceptable tests of IOS vs spirometry were 58% vs 57% (P = .9), 74% vs 70% (P = .4), 79% vs 88% (P = .02), and 86% vs 90% (P = .3).
Fig 2
Fig 2
Children with RV wheezing illnesses had significantly lower FEV1 at ages 5 through 8 years. In contrast with RV, children with RSV wheezing illnesses did not have significant differences in FEV1 at any age compared with children who did not wheeze with RSV. Circles and triangles represent means, and bars represent 95% CI. Results were obtained by using linear mixed-effects regression model using FEV1 obtained from children aged 5 through 8 years adjusted for age, race, gender, height, weight, asthma, RV wheeze, RSV wheeze, non-RV/non-RSV wheeze, passive smoke exposure, and age at the first occurrence of positive aeroallergen FEIA. Significant differences between treatment groups denoted by ∗P < .05 and ∗∗P < .01.
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