Meta-Analysis

. 2022 Oct 6;60(4):2102395.

doi: 10.1183/13993003.02395-2021. Print 2022 Oct.

Early-life respiratory tract infections and the risk of school-age lower lung function and asthma: a meta-analysis of 150 000 European children

Evelien R van Meel^{1

2}, Sara M Mensink-Bout^{1

2}, Herman T den Dekker^{1

2

3}, Tarunveer S Ahluwalia^{4

5}, Isabella Annesi-Maesano⁶, Syed Hasan Arshad^{7

8

9}, Nour Baïz⁶, Henrique Barros^{10

11}, Andrea von Berg¹², Hans Bisgaard⁴, Klaus Bønnelykke⁴, Christian J Carlsson⁴, Maribel Casas^{13

14

15}, Leda Chatzi¹⁶, Cecile Chevrier¹⁷, Geertje Dalmeijer¹⁸, Carol Dezateux¹⁹, Karel Duchen²⁰, Merete Eggesbø²¹, Cornelis van der Ent²², Maria Fantini²³, Claudia Flexeder²⁴, Urs Frey²⁵, Fransesco Forastiere²⁶, Ulrike Gehring²⁷, Davide Gori²³, Raquel Granell²⁸, Lucy J Griffiths²⁹, Hazel Inskip^{9

30}, Joanna Jerzynska³¹, Anne M Karvonen³², Thomas Keil^{33

34

35}, Cecily Kelleher³⁶, Manolis Kogevinas^{13

14

37

38}, Gudrun Koppen³⁹, Claudia E Kuehni^{40

41}, Nathalie Lambrechts³⁹, Susanne Lau⁴², Irina Lehmann⁴³, Johnny Ludvigsson²⁰, Maria Christine Magnus^{28

44}, Erik Mélen⁴⁵, John Mehegan³⁶, Monique Mommers⁴⁶, Anne-Marie Nybo Andersen⁴⁷, Wenche Nystad⁴⁸, Eva S L Pedersen⁴⁰, Juha Pekkanen^{32

49}, Ville Peltola⁵⁰, Katharine C Pike⁵¹, Angela Pinot de Moira⁴⁹, Costanza Pizzi⁵², Kinga Polanska³¹, Maja Popovic⁵², Daniela Porta²⁶, Graham Roberts^{7

8

9}, Ana Cristina Santos¹⁰, Erica S Schultz⁴⁵, Marie Standl^{24

53}, Jordi Sunyer^{13

14

15

38}, Carel Thijs⁴⁶, Laura Toivonen⁵⁰, Eleonora Uphoff⁵⁴, Jakob Usemann²⁵, Marina Vafeidi⁵⁵, John Wright⁵⁴, Johan C de Jongste², Vincent W V Jaddoe^{1

3

56}, Liesbeth Duijts^{57

58}

Affiliations

¹ The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
² Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
³ Dept of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
⁴ COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
⁵ Steno Diabetes Center Copenhagen, Gentofte, Denmark.
⁶ Sorbonne Université and INSERM, Epidemiology of Allergic and Respiratory Diseases Dept (EPAR), Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Saint-Antoine Medical School, Paris, France.
⁷ The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK.
⁸ Faculty of Medicine, University of Southampton, Southampton, UK.
⁹ NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
¹⁰ EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
¹¹ Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
¹² Research Institute, Dept of Pediatrics, Marien-Hospital Wesel, Wesel, Germany.
¹³ ISGlobal, Barcelona, Spain.
¹⁴ Universitat Pompeu Fabra (UPF), Barcelona, Spain.
¹⁵ CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
¹⁶ Dept of Preventive Medicine, University of Southern California, Los Angeles, CA, USA.
¹⁷ University Rennes, Inserm, Irset UMR_S 1085, Rennes, France.
¹⁸ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
¹⁹ Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
²⁰ Crown Princess Victoria Children's Hospital and Division of Pediatrics, Dept of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
²¹ Norwegian Institute of Public Health, Oslo, Norway.
²² Dept of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
²³ Dept of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
²⁴ Institute of Epidemiology I, Helmholtz Zentrum München, Munich, Germany.
²⁵ University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland.
²⁶ Dept of Epidemiology, Lazio Regional Health Service, Rome, Italy.
²⁷ Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
²⁸ MRC Intergrative Epidemiology Unit, Dept of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
²⁹ Population Data Science, Swansea University Medical School, Swansea, UK.
³⁰ MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
³¹ Dept of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland.
³² Dept of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland.
³³ Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.
³⁴ Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzberg, Germany.
³⁵ State Institute for Health, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany.
³⁶ School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
³⁷ National School of Public Health, Athens, Greece.
³⁸ Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
³⁹ Flemish Institute for Technological Research (VITO), Environmental Risk and Health Unit, Mol, Belgium.
⁴⁰ Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
⁴¹ Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland.
⁴² Dept of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
⁴³ Dept of Environmental Immunology, Helmholtz Centre for Environmental Research Leipzig - UFZ, Leipzig, Germany.
⁴⁴ Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
⁴⁵ Dept of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Sach's Children Hospital, Stockholm, Sweden.
⁴⁶ Dept of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre+, Maastricht, The Netherlands.
⁴⁷ Dept of Public Health, University of Copenhagen, Copenhagen, Denmark.
⁴⁸ Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
⁴⁹ Dept of Public Health, University of Helsinki, Helsinki, Finland.
⁵⁰ Dept of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.
⁵¹ Bristol Royal Hospital for Children, Bristol, UK.
⁵² Dept of Medical Sciences, University of Turin, Turin, Italy.
⁵³ German Research Center for Environmental Health, Munich, Germany.
⁵⁴ Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
⁵⁵ Dept of Social Medicine, University of Crete, Heraklion, Greece.
⁵⁶ Dept of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
⁵⁷ Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands l.duijts@erasmusmc.nl.
⁵⁸ Dept of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.

PMID: 35487537
PMCID: PMC9535116
DOI: 10.1183/13993003.02395-2021

Meta-Analysis

Early-life respiratory tract infections and the risk of school-age lower lung function and asthma: a meta-analysis of 150 000 European children

Evelien R van Meel et al. Eur Respir J. 2022.

. 2022 Oct 6;60(4):2102395.

doi: 10.1183/13993003.02395-2021. Print 2022 Oct.

Authors

Affiliations

¹ The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
² Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
³ Dept of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
⁴ COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
⁵ Steno Diabetes Center Copenhagen, Gentofte, Denmark.
⁶ Sorbonne Université and INSERM, Epidemiology of Allergic and Respiratory Diseases Dept (EPAR), Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Saint-Antoine Medical School, Paris, France.
⁷ The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK.
⁸ Faculty of Medicine, University of Southampton, Southampton, UK.
⁹ NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
¹⁰ EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
¹¹ Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
¹² Research Institute, Dept of Pediatrics, Marien-Hospital Wesel, Wesel, Germany.
¹³ ISGlobal, Barcelona, Spain.
¹⁴ Universitat Pompeu Fabra (UPF), Barcelona, Spain.
¹⁵ CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
¹⁶ Dept of Preventive Medicine, University of Southern California, Los Angeles, CA, USA.
¹⁷ University Rennes, Inserm, Irset UMR_S 1085, Rennes, France.
¹⁸ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
¹⁹ Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
²⁰ Crown Princess Victoria Children's Hospital and Division of Pediatrics, Dept of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
²¹ Norwegian Institute of Public Health, Oslo, Norway.
²² Dept of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
²³ Dept of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
²⁴ Institute of Epidemiology I, Helmholtz Zentrum München, Munich, Germany.
²⁵ University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland.
²⁶ Dept of Epidemiology, Lazio Regional Health Service, Rome, Italy.
²⁷ Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
²⁸ MRC Intergrative Epidemiology Unit, Dept of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
²⁹ Population Data Science, Swansea University Medical School, Swansea, UK.
³⁰ MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
³¹ Dept of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland.
³² Dept of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland.
³³ Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.
³⁴ Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzberg, Germany.
³⁵ State Institute for Health, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany.
³⁶ School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
³⁷ National School of Public Health, Athens, Greece.
³⁸ Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
³⁹ Flemish Institute for Technological Research (VITO), Environmental Risk and Health Unit, Mol, Belgium.
⁴⁰ Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
⁴¹ Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland.
⁴² Dept of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
⁴³ Dept of Environmental Immunology, Helmholtz Centre for Environmental Research Leipzig - UFZ, Leipzig, Germany.
⁴⁴ Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
⁴⁵ Dept of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Sach's Children Hospital, Stockholm, Sweden.
⁴⁶ Dept of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre+, Maastricht, The Netherlands.
⁴⁷ Dept of Public Health, University of Copenhagen, Copenhagen, Denmark.
⁴⁸ Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
⁴⁹ Dept of Public Health, University of Helsinki, Helsinki, Finland.
⁵⁰ Dept of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.
⁵¹ Bristol Royal Hospital for Children, Bristol, UK.
⁵² Dept of Medical Sciences, University of Turin, Turin, Italy.
⁵³ German Research Center for Environmental Health, Munich, Germany.
⁵⁴ Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
⁵⁵ Dept of Social Medicine, University of Crete, Heraklion, Greece.
⁵⁶ Dept of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
⁵⁷ Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands l.duijts@erasmusmc.nl.
⁵⁸ Dept of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.

PMID: 35487537
PMCID: PMC9535116
DOI: 10.1183/13993003.02395-2021

Abstract

Background: Early-life respiratory tract infections might affect chronic obstructive respiratory diseases, but conclusive studies from general populations are lacking. Our objective was to examine if children with early-life respiratory tract infections had increased risks of lower lung function and asthma at school age.

Methods: We used individual participant data of 150 090 children primarily from the EU Child Cohort Network to examine the associations of upper and lower respiratory tract infections from age 6 months to 5 years with forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), FEV₁/FVC, forced expiratory flow at 75% of FVC (FEF_75%) and asthma at a median (range) age of 7 (4-15) years.

Results: Children with early-life lower, not upper, respiratory tract infections had a lower school-age FEV₁, FEV₁/FVC and FEF_75% (z-score range: -0.09 (95% CI -0.14- -0.04) to -0.30 (95% CI -0.36- -0.24)). Children with early-life lower respiratory tract infections had a higher increased risk of school-age asthma than those with upper respiratory tract infections (OR range: 2.10 (95% CI 1.98-2.22) to 6.30 (95% CI 5.64-7.04) and 1.25 (95% CI 1.18-1.32) to 1.55 (95% CI 1.47-1.65), respectively). Adjustment for preceding respiratory tract infections slightly decreased the strength of the effects. Observed associations were similar for those with and without early-life wheezing as a proxy for early-life asthma.

Conclusions: Our findings suggest that early-life respiratory tract infections affect development of chronic obstructive respiratory diseases in later life, with the strongest effects for lower respiratory tract infections.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: T.S. Ahluwalia received funding for the current manuscript from the Novo Nordisk Foundation (NNF180C0052457). I. Annesi-Maesano is member of the ATS Environment Health Policy Committee, the ERS Ethics and Integrity Committee, and the French IRD Ethics Committee. S.H. Arshad received funding for the manuscript from Asthma UK (364) and National Institutes of Health USA (R01HL082925). H. Bisgaard received funding for the current manuscript from the Lundbeck Foundation (R16-A1694), Ministry of Health (903516), Danish Council for Strategic Research (0603-00280B) and Capital Region Research Foundation. M. Eggesbø received paid honorarium for making small videos relating to allergy and asthma, by the Norwegian LHL organisation. U. Frey received funding for the manuscript from the Swiss National Science Foundation (320030_204717/1), and is chair of the National Steering Board, Swiss Personalized Health Network (SPHN). H. Inskip received funding for the manuscript from the UK Medical Research Council and the European Union, and was President for the Society for Social Medicine and Population Health. J. Jerzynska received funding for the current manuscript from the National Science Centre, Poland (DEC-2014/15/B/N27/00998). A.M. Karvonen received funding for the present manuscript from the Academy of Finland (139021, 287675, 296814, 296817, 308254), Juho Vainio Foundation, EVO/VTR funding, Pavivikki and Sakari Sohlberg Foundation, Farmers’ Social Insurance Institution (Mela), Finnish Cultural Foundation, Foundation for Pediatric Research, and the European Union (QLK4-CT-2001-0250). M. Mommers received grants from the Research Council of Norway (262700) and European Research Council (947684). A. Pinot de Moira received a Lundbeck Foundation fellowship (R264-2017-3099). V. Peltola received funding for the present manuscript from the Academy of Finland and Foundation for Pediatric Research Finland. K.C. Pike received consulting fees from Novartis and Spiriva, payment or honoraria for lectures from Novartis, and is participating on a data safety monitoring board or advisory board for Adherium. K. Polanska received funding for the current manuscript from the National Science Centre, Poland (DEC-2014/15/B/N27/00998), grant PRNF-218-AI-1/07 from Norway through the Norwegian Financial Mechanisms within the Polish–Norwegian Research Fund, and the Ministry of Science and Higher Education, Poland (PBZ-MEiN-/8/2//2006). G. Roberts is president of the BSACI. A.C. Santos received funding for the current manuscript from FCT Investigators contracts (IF/01060/2015). J. Sunyer received a grant from the European Research Council (Prenatal exposure to urban AIR pollution and pre- and postNatal Brain development (AIR-NB), 785994). J. Usemann received grants from the Palatin Foundation, University of Basel Switzerland, Swiss Cancer League and Swiss Lung Foundation, and payments or honoraria for lectures from Vertex and Zurich Lung Foundation. V.W.V. Jaddoe received a grant from the European Research Council (ERC-2014-CoG-648916). L. Duijts received funding from cofunded ERA-Net on Biomarkers for Nutrition and Health (ERA HDHL), Horizon 2020 (696295; 2017), the Netherlands Organisation for Health Research and Development (ZonMw; 529051014; 2017), Science Foundation Ireland (SFI/16/ERA-HDHL/3360), and the European Union (ALPHABET project). All other authors declare no conflict of interest.

Figures

**FIGURE 1**
Associations of early-life a–c) upper and d–f) lower respiratory tract infections with school age: a, d) forced expiratory volume in 1 s (FEV₁), b, e) FEV₁/forced vital capacity (FVC) and c, f) forced expiratory flow at 75% of FVC (FEF_75%). Data are presented as change in z-score (95% confidence interval), derived from multilevel linear regression models. The dark blue diamonds represent models adjusted for maternal history of asthma and atopy, ethnicity, education level, smoking during pregnancy, parity and pet keeping, and child's sex, gestational age at birth, birthweight, season of birth, breastfeeding, and daycare attendance. The light blue circles represent models additionally adjusted for preceding a–c) upper or d–f) lower respiratory tract infections. *: p<0.05; **: p<0.01.

**FIGURE 2**
Associations of early-life a) upper and b) lower respiratory tract infections with school-age asthma. Data are presented as odds ratio (95% confidence interval), derived from multilevel logistic regression models. The dark blue diamonds represent models adjusted for maternal history of asthma and atopy, ethnicity, education level, smoking during pregnancy, parity and pet keeping, and child's sex, gestational age at birth, birthweight, season of birth, breastfeeding and daycare attendance. The light blue circles represent models additionally adjusted for preceding a) upper or b) lower respiratory tract infections. p-values all <0.01.

See this image and copyright information in PMC

Comment in

Reply to: Early-life respiratory infections and pre-adult asthma: could there be an interaction and differential misclassification?
van Meel ER, Duijts L; participating authors of the meta-analysis “Early-life respiratory tract infections and the risk of school-age lower lung function and asthma”. van Meel ER, et al. Eur Respir J. 2022 Nov 10;60(5):2201384. doi: 10.1183/13993003.01384-2022. Print 2022 Nov. Eur Respir J. 2022. PMID: 35896205 Free PMC article.
Early-life respiratory infections and pre-adult asthma: could there be an interaction and differential misclassification?
Perret JL, Dharmage SC, Bui DS. Perret JL, et al. Eur Respir J. 2022 Nov 10;60(5):2201141. doi: 10.1183/13993003.01141-2022. Print 2022 Nov. Eur Respir J. 2022. PMID: 35896212 Free PMC article.
The lower respiratory tract: the hot spot for chronic fixed airflow limitation.
Polverino F, Marin JM. Polverino F, et al. Eur Respir J. 2022 Oct 6;60(4):2201214. doi: 10.1183/13993003.01214-2022. Print 2022 Oct. Eur Respir J. 2022. PMID: 36202404 No abstract available.

References

1. Chonmaitree T, Revai K, Grady JJ, et al. . Viral upper respiratory tract infection and otitis media complication in young children. Clin Infect Dis 2008; 46: 815–823. doi:10.1086/528685 - DOI - PMC - PubMed
1. Rudan I, Boschi-Pinto C, Biloglav Z, et al. . Epidemiology and etiology of childhood pneumonia. Bull World Health Organ 2008; 86: 408–416. doi:10.2471/BLT.07.048769 - DOI - PMC - PubMed
1. Openshaw PJ, Tregoning JS. Immune responses and disease enhancement during respiratory syncytial virus infection. Clin Microbiol Rev 2005; 18: 541–555. doi:10.1128/CMR.18.3.541-555.2005 - DOI - PMC - PubMed
1. Holt PG. Programming for responsiveness to environmental antigens that trigger allergic respiratory disease in adulthood is initiated during the perinatal period. Environ Health Perspect 1998; 106: Suppl. 3, 795–800. doi:10.1289/ehp.98106795 - DOI - PMC - PubMed
1. Daley D. The evolution of the hygiene hypothesis: the role of early-life exposures to viruses and microbes and their relationship to asthma and allergic diseases. Curr Opin Allergy Clin Immunol 2014; 14: 390–396. doi:10.1097/ACI.0000000000000101 - DOI - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

LinkOut - more resources

Full Text Sources
Other Literature Sources
- H1 Connect - Access expert opinions and insights on biomedical research.
Medical
- MedlinePlus Consumer Health Information
- MedlinePlus Health Information
Miscellaneous
- Xenbase

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Early-life respiratory tract infections and the risk of school-age lower lung function and asthma: a meta-analysis of 150 000 European children

Affiliations

Early-life respiratory tract infections and the risk of school-age lower lung function and asthma: a meta-analysis of 150 000 European children

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Miscellaneous