Role Of Viral Coinfections In Asthma Development In Children With Severe Bronchiolitis In Early Childhood

Abstract

Background: Severe viral bronchiolitis is associated with a higher risk of developing asthma, but little is known about the medium-term prognosis and the lung function evolution of patients admitted for viral coinfection-associated bronchiolitis. Our main objective was to compare the lung function, the prevalence of asthma and the rate of allergic sensitization at 6-9 years in children hospitalized for bronchiolitis with viral coinfection versus single viral infection. Methods: Observational, longitudinal study in children previously hospitalized for viral bronchiolitis with current age between 6-9 years. Clinical and epidemiological data were collected. Fraction of exhaled nitric oxide determination, spirometry and skin prick test for common aeroallergens were performed. Results: A total of 244 bronchiolitis-admitted children (52 coinfections and 192 single infections), with current age 6-9 years, accepted to participate by telephone answering the clinical questionnaires. Of them, 181 patients agreed for a medical visit. The overall frequency of asthma was 21%, being this prevalence almost twice as high in the viral coinfection group (p = 0.049). The coinfection cohort had more than twice as many admissions (p = 0.04), was more likely to receive montelukast (p = 0.06) and salmeterol/fluticasone treatment (p = 0.03) than the single-infection one. No differences regarding lung function values or allergic sensitization rate were observed between both groups. The variables independently related to current asthma at 6-9 years were: viral coinfection during bronchiolitis (p = 0.004), allergic rhinitis (p = 0.001), food allergy (p = 0.05) and atopic dermatitis (p = 0.017). Conclusions: Severe bronchiolitis associated with double or multiple viral detection in the first 24 months is an independent risk factor for higher frequency and greater severity of asthma at 6-9 years, being this risk almost three times higher compared to single infection. This fact is suggested by the higher frequency of current asthma, symptoms in intercrisis periods, maintenance anti-asthma treatment and number of hospitalizations for recurrent wheezing in children with coinfection compared to single infection. Early viral etiology identification in severe bronchiolitis might facilitate the prompt prediction and treatment of asthma in school age.