Risk of current asthma among adult smokers with respiratory syncytial virus illnesses in early life

Abstract

Rationale: Risk of subsequent asthma-like symptoms after early-life lower respiratory illness (LRI) caused by respiratory syncytial virus (RSV) is increased during the first decade of childhood and diminished thereafter by adolescence.

Objectives: To determine the relation of early-life RSV-LRI on adult asthma-like symptoms and its interactive role with adult smoking.

Methods: A total of 1,246 nonselected infants were enrolled at birth and prospectively followed. Virologically confirmed RSV-LRIs were assessed during the first 3 years of life. At age 22, 24, 26, and 29 years, current asthma and smoking behavior were evaluated by questionnaire. Peak flow variability was assessed at age 26 and expressed as amplitude % mean. A longitudinal analysis was used to investigate the relation of RSV-LRI and active smoking to adult outcomes.

Measurements and main results: Neither RSV-LRI nor active smoking were directly associated with increased current adult asthma or peak flow variability. However, there was a significant interaction between RSV-LRI and active smoking in relation to current asthma (P for interaction = 0.004) and peak flow variability (P for interaction = 0.04). Among subjects with early RSV-LRI, those who actively smoked were 1.7 times more likely to have current asthma (95% confidence interval, 1.2-2.3; P = 0.003) and had greater amplitude % mean (10.0% vs. 6.4%; P = 0.02) than nonsmokers. Among subjects without early RSV-LRI, there was no difference in asthma risk or peak flow variability between active smokers and nonsmokers.

Conclusions: Smoking is associated with increased risk of having asthma in young adults who had RSV-LRI in early life but not among subjects without these illnesses.

Keywords: adult; asthma; respiratory syncytial virus; smoking.

Figure 1.

Adjusted relative risk of current adult asthma by smoking status among subjects with and without early-life respiratory syncytial virus (RSV) lower respiratory illness (LRI). Among subjects with early RSV-LRI, active smoking was associated with an increased risk of current asthma (relative risk [RR], 1.66; 95% confidence interval [CI], 1.19–2.31; P = 0.003). The effect of smoking on asthma was not observed among those without an early RSV-LRI (RR, 0.90; 95% CI, 0.70–1.15; P = 0.39). Data were analyzed by generalized estimating equation adjusted for age, sex, parental asthma, and maternal smoking at enrollment.

Figure 2.

Amplitude % mean (as an index of peak flow variability) among adult participants with and without respiratory syncytial virus (RSV) lower respiratory illness (LRI) in the first 3 years of life by smoking status. The box plots show the median (middle line), 25th and 75th percentiles (box), and 90th and 10th percentiles (whiskers). The figures on the right of each box plot display the mean and 95% confidence interval. n = 157, 43, 51, and 18 from left to right, respectively.