Rhinovirus-induced first wheezing episode predicts atopic but not non-atopic asthma at school-age

Publication date: Available online 25 March 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Minna Lukkarinen, Annamari Koistinen, Riitta Turunen, Pasi Lehtinen, Tytti Vuorinen, Tuomas Jartti
BackgroundPersistent childhood asthma is mainly atopy-driven. However, limited data exist on the risk factors for childhood asthma phenotypes.ObjectiveTo identify risk factors at the first severe wheezing episode for the current asthma 7 years later, and separately for atopic and non-atopic asthma.MethodsOne hundred and twenty-seven steroid-naive children with the first severe wheezing episode (90% hospitalized/10% emergency room treated) were followed for 7 years. The primary outcome was current asthma at age 8 years, which was also analyzed separately as atopic and non-atopic asthma. Risk factors including sensitization, viral etiology and other main asthma risk factors were analyzed.ResultsAt study entry, median age was 11 months (interquartile range 6;16 months), 17% were sensitized and 98% were virus-positive. Current asthma (n = 37) at 8 years was divided to atopic (n = 19) and non-atopic (n = 18) asthma. The risk factors for current atopic asthma at study entry were sensitization (adjusted odds ratio 12; P<.001), eczema (4.8; P .014, respectively) and wheezing with rhinovirus (5.0; P .035). The risk factors for non-atopic asthma were the first severe respiratory syncytial virus/rhinovirus-negative wheezing episode (adjusted odds ratio 8.0; P .001), first wheezing episode at age <12 months (7.3; P = .007, respectively), and parental smoking (3.8; P .028).ConclusionsThe data suggest diverse asthma phenotypes and mechanisms that can be predicted using simple clinical markers at the time of the first severe wheezing episode. Findings are important in designing early intervention strategies for secondary prevention of asthma. (ClinicalTrials.gov number, NCT00494624 and NCT00731575)

Teaser

The data suggest that sensitization, eczema and the rhinovirus etiology and atopic characteristics already at the first severe wheezing episode predict atopic but not non-atopic asthma at age 8 years, and therefore are worth assessing early.


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