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DOI: 10.1055/s-0040-1716968
Association between Respiratory Syncytial Virus Hospitalization and Subsequent Asthma in Children Born Prematurely
Publication History
Publication Date:
08 September 2020 (online)
Introduction Premature birth is a well-established risk factor for respiratory syncytial virus hospitalization (RSVH). A growing body of evidence suggests that RSVH in early childhood is associated with increased rates of transient, recurrent wheezing, and possibly asthma. This study investigated the association between RSVH and asthma in preterm children followed-up to 18 years of age.
Materials and Methods All preterm children (<37 weeks’ gestational age [wGA]) in Scotland born 1996 to 2011 were followed until 18 years of age or until study end (2014) using the Information Services Division databases. Asthma-related hospitalizations (International Classification of Diseases, 10th revision [ICD-10] codes J45 and J46) and use of asthma medications (bronchodilators, corticosteroids, cromoglycate and related therapy, leukotriene receptor antagonists, and phosphodiesterase type-4 inhibitors) were assessed alongside a composite outcome of “confirmed asthma” (asthma admission and medication use) in children with and without a RSVH (J12.1, J20.5, and J21.0) during first 2 years of life.
Results Of 52,363 preterm children, 2,794 (5.3%) had ≥1 RSVH at ≤2 years. RSVH incidence significantly (p < 0.0001) decreased with increasing wGA: 13.6% in <29 wGA, 8.3% in 29 to 32 wGA, 4.7% in 33 to 35 wGA, and 3.9% in 36 wGA. RSVH was associated with significantly increased rates of asthma admissions (relative risk [RR]: 2.6, 95% CI: 2.3–2.9, p < 0.0001), asthma medication use (RR: 1.7, 95% confidence interval [CI]: 1.6–1.8, p < 0.0001), and confirmed asthma (RR: 2.5, 95% CI: 2.2–2.9, p < 0.0001) in preterm (<37 wGA) children ([Table A004]). Significantly higher asthma rates and medication use in children with RSVH were seen in all wGA groups assessed (<29, 29–32, 33–35, and 36 wGA; p < 0.0001 for all in group comparisons). Children born <29 wGA with RSVH had the highest incidence of asthma admission (13.6%), asthma medication use (34.9%), and confirmed asthma (8.0%), with rates remaining fairly consistent for those born 29 to 36 wGA (asthma admission: 9.0–9.5%; medication use: 26.7–29.0%; confirmed asthma: 5.1–6.3%).
Conclusion This study provides further evidence that RSVH in early childhood in preterm children was associated with significantly increased rates of asthma.
|
<29 wGA |
29–32 wGA |
33–35 wGA |
36 wGA |
<37 wGA |
||||||
|
RSVH |
No-RSVH |
RSVH |
No-RSVH |
RSVH |
No-RSVH |
RSVH |
No-RSVH |
RSVH |
No-RSVH |
|
|
RSVH incidence, % (n/N) |
13.6% (327/2,401) |
8.3% (666/8,046) |
4.7% (1,037/22,266) |
3.9% (764/19,650) |
5.3% (2,794/52,363) |
|||||
|
Asthma admission, % (n/N) |
13.8% (45/327) |
5.7% (119/2,074) |
9.2% (61/666) |
4.3% (321/7,380) |
9.5% (99/1,037) |
3.8% (817/21,229) |
9.0% (69/764) |
3.2% (595/18,886) |
9.8% (274/2,794) |
3.7% (1,852/49,569) |
|
Asthma admission rate, /1,000 (N) |
293.6 (96) |
125.8 (261) |
181.7 (121) |
102.3 (755) |
258.2 (268) |
72.6 (1,542) |
253.9 (194) |
64.3 (1,214) |
243.0 (679) |
76.1 (3,772) |
|
Antiasthma medication, % (n/N) |
34.9% (114/327) |
25.1% (520/2,074) |
29.0% (193/666) |
20.3% (1,499/7,380) |
26.9% (279/1,037) |
17.8% (3,785/21,229) |
26.7% (204/764) |
16.7% (3,152/18,886) |
28.3% (790/2,794) |
18.1% (8,956/49,569) |
|
Confirmed asthma, % (n/N) |
8.0% (26/327) |
3.3% (68/2,074) |
5.7% (38/666) |
2.6% (190/7,380) |
5.1% (53/1,037) |
2.4% (500/21,229) |
6.3% (48/764) |
1.8% (348/18,886) |
5.9% (165/2,794) |
2.2% (1,106/49,569) |
Abbreviations: RSVH, respiratory syncytial virus hospitalization; wGA, weeks’ gestational age.
Conflict of Interest
None declared.