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Selective Blockade of TNFR1 Improves Clinical Disease and Bronchoconstriction in Experimental RSV Infection. Viruses 2020; 12:v12101176. [PMID: 33080861 PMCID: PMC7588931 DOI: 10.3390/v12101176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis in infants and young children. Although some clinical studies have speculated that tumor necrosis factor (TNF)-α is a major contributor of RSV-mediated airway disease, experimental evidence remains unclear or conflicting. TNF-α initiates inflammation and cell death through two distinct receptors: TNF-receptor (TNFR)1 and TNFR2. Here we delineate the function of TNF-α by short-lasting blockade of either receptor in an experimental BALB/c mouse model of RSV infection. We demonstrate that antibody-mediated blockade of TNFR1, but not TNFR2, results in significantly improved clinical disease and bronchoconstriction as well as significant reductions of several inflammatory cytokines and chemokines, including IL-1α, IL-1β, IL-6, Ccl3, Ccl4, and Ccl5. Additionally, TNFR1 blockade was found to significantly reduce neutrophil number and activation status, consistent with the concomitant reduction of pro-neutrophilic chemokines Cxcl1 and Cxcl2. Similar protective activity was also observed when a single-dose of TNFR1 blockade was administered to mice following RSV inoculation, although this treatment resulted in improved alveolar macrophage survival rather than reduced neutrophil activation. Importantly, short-lasting blockade of TNFR1 did not affect RSV peak replication in the lung. This study suggests a potential therapeutic approach for RSV bronchiolitis based on selective blockade of TNFR1.
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Salka K, Arroyo M, Chorvinsky E, Abutaleb K, Perez GF, Wolf S, Xuchen X, Weinstock J, Gutierrez MJ, Pérez-Losada M, Pillai DK, Nino G. Innate IFN-lambda responses to dsRNA in the human infant airway epithelium and clinical regulatory factors during viral respiratory infections in early life. Clin Exp Allergy 2020; 50:1044-1054. [PMID: 32623773 PMCID: PMC7484417 DOI: 10.1111/cea.13701] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION IFN lambda (type III-IFN-λ1) is a molecule primarily produced by epithelial cells that provides an important first-line defence against viral respiratory infections and has been linked to the pathogenesis of viral-induced wheezing in early life. The goal of this study was to better understand the regulation of innate IFN-lambda responses in vitro in primary human infant airway epithelial cells (AECs) and in vivo using nasal aspirates during viral respiratory infections. METHODS IFN-lambda protein levels were quantified: (a) in human infant AECs exposed to (poly(I:C) dsRNA) under different experimental conditions (n = 8 donors); and (b) in nasal aspirates of young children (≤3 years) hospitalized with viral respiratory infection (n = 138) and in uninfected controls (n = 74). In vivo IFN-lambda airway levels during viral infections were correlated with individual characteristics and respiratory disease parameters. RESULTS Our in vitro experiments showed that the poly(I:C)-induced innate production of IFN lambda in human infant AECs is regulated by (a) p38-MAPK/NF-kB dependent mechanism; and (b) exposure to pro-inflammatory signals such as IL1β. Our in vivo studies demonstrated that (a) infants (<18 months) had higher virus-induced IFN-lambda airway secretion; (b) subjects with RSV infection showed the highest IFN-lambda airway levels; and (c) individuals with the highest virus-induced IFN-lambda levels (>90th percentile) had higher viral loads and were more likely to have respiratory sick visits within 12 months of discharge (OR = 5.8). CONCLUSION IFN-lambda responses to dsRNA in the human infant airway epithelium are regulated by p38-MAPK and NF-kB signalling. High in vivo IFN-lambda production is influenced by virus type and associated with recurrent respiratory sick visits in young children.
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Affiliation(s)
- Kyle Salka
- Division of Pediatric Pulmonary and Sleep Medicine. Children’s National Medical Center, George Washington University, Washington, D.C, USA
| | - Maria Arroyo
- Division of Pediatric Pulmonary and Sleep Medicine. Children’s National Medical Center, George Washington University, Washington, D.C, USA
| | - Elizabeth Chorvinsky
- Division of Pediatric Pulmonary and Sleep Medicine. Children’s National Medical Center, George Washington University, Washington, D.C, USA
| | - Karima Abutaleb
- Division of Pediatric Pulmonary and Sleep Medicine. Children’s National Medical Center, George Washington University, Washington, D.C, USA
| | - Geovanny F. Perez
- Division of Pediatric Pulmonary and Sleep Medicine. Children’s National Medical Center, George Washington University, Washington, D.C, USA
| | - Seth Wolf
- Division of Pediatric Pulmonary and Sleep Medicine. Children’s National Medical Center, George Washington University, Washington, D.C, USA
| | - Xilei Xuchen
- Division of Pediatric Pulmonary and Sleep Medicine. Children’s National Medical Center, George Washington University, Washington, D.C, USA
| | - Jered Weinstock
- Division of Pediatric Pulmonary and Sleep Medicine. Children’s National Medical Center, George Washington University, Washington, D.C, USA
| | - Maria J. Gutierrez
- Division of Pediatric Allergy and Immunology, Johns Hopkins University, Baltimore, MD
| | - Marcos Pérez-Losada
- Computational Biology Institute, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
- CIBIO-InBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, Universidade do Porto, Campus Agrário de Vairão, 4485-661, Vairão, Portugal
| | - Dinesh K. Pillai
- Division of Pediatric Pulmonary and Sleep Medicine. Children’s National Medical Center, George Washington University, Washington, D.C, USA
| | - Gustavo Nino
- Division of Pediatric Pulmonary and Sleep Medicine. Children’s National Medical Center, George Washington University, Washington, D.C, USA
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Falahi S, Sayyadi H, Abdoli A, Kenarkoohi A, Mohammadi S. The prevalence of human bocavirus in <2-year-old children with acute bronchiolitis. New Microbes New Infect 2020; 37:100736. [PMID: 32983545 PMCID: PMC7493080 DOI: 10.1016/j.nmni.2020.100736] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 11/23/2022] Open
Abstract
Acute bronchiolitis is one of the most common lower respiratory tract infections in children with less than 2 years of age. Nowadays, molecular methods provide an opportunity to better understand the etiology of bronchiolitis. Several viral agents including Respiratory syncytial virus (RSV), Rhinovirus, Parainfluenza and Human bocavirus (HBoV) are responsible for acute bronchiolitis. There are growing studies on the prevalence of HBoV in patients with bronchiolitis. The present systematic review and meta-analysis were conducted to determine the pooled prevalence of HBoV in the respiratory samples of children with acute bronchiolitis. A literature search was conducted in the databases of PubMed, Scopus and Web of Science to recruit studies reporting the frequency of HBoV in <2-year-old children with acute bronchiolitis from 2005 to 2019. Only studies that used polymerase chain reaction (PCR)-based methods to detect the virus in nasopharyngeal samples were included. A total of 22 studies assessing 6751 cases were analyzed. According to the meta-analysis based on the random-effects model, the overall prevalence of HBoV in children with <2 years old was obtained 13% (95% CI: 0.09-0.17). Additionally, the rates of single (as the sole organism) and mixed (in combination with other viruses) HBoV infections were 4% and 9%, respectively. This study showed a high rate of HBoV detection in children with acute bronchiolitis. This should be considered as part of a diagnostic test panel for respiratory infections in children with bronchiolitis.
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Affiliation(s)
- S. Falahi
- Zoonotic Diseases Research Center, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - H. Sayyadi
- Department of Biostatistics, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - A. Abdoli
- Department of Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
- Zoonoses Research Centre, Jahrom University of Medical Sciences, Jahrom, Iran
| | - A. Kenarkoohi
- Department of Microbiology, Faculty of Medicine, School of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
| | - S. Mohammadi
- Department of Operating Room, School of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
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Arroyo M, Salka KP, Perez GF, Rodriguez-Martinez CE, Castro-Rodriguez JA, Nino G. Bedside clinical assessment predicts recurrence after hospitalization due to viral lower respiratory tract infection in young children. J Investig Med 2019; 68:756-761. [PMID: 31806672 DOI: 10.1136/jim-2019-001024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2019] [Indexed: 12/13/2022]
Abstract
Infants requiring hospitalization due to a viral lower respiratory tract infection (LRTI) have a high risk of developing recurrent respiratory illnesses in early life and asthma beyond childhood. Notably, all validated clinical scales for viral LRTI have focused on predicting acute severity instead of recurrence. We present a novel clinical approach combining individual risk factors with bedside clinical parameters to predict recurrence after viral LRTI hospitalization in young children. A retrospective longitudinal cohort of young children (≤3 years) designed to define clinical predictive factors of recurrent respiratory illnesses within 12 months after hospitalization due to PCR-confirmed viral LRTI. Data collection was through electronic medical record. We included 138 children hospitalized with viral LRTI. Using automatic stepwise logistic model selection, we found that the strongest predictors of recurrence in infants hospitalized for the first time were severe prematurity (≤32 weeks' gestational age, OR=5.19; 95% CI 1.76 to 15.32; p=0.002) and a clinical score that weighted hypoxemia, subcostal retractions and wheezing (OR=3.33; 95% CI 1.59 to 6.98; p<0.001). After the first hospitalization, the strongest predictors of subsequent episodes were wheezing (OR=5.62; 95% CI 1.03 to 30.62; p=0.04) and family history of asthma (OR=5.39; 95% CI 1.04 to 27.96; p=0.04). We found that integrating individual risk factors (eg, prematurity or family history of asthma) with bedside clinical assessment (eg, wheezing, subcostal retractions or hypoxemia) can predict the risk of recurrence after viral LRTI hospitalization in infants. This strategy may enable clinically oriented subsetting of infants with viral LRTI based on individual predictors for recurrent respiratory illnesses during early life.
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Affiliation(s)
- Maria Arroyo
- Pediatric Pulmonary and Sleep Medicine, Childrens National Medical Center, Washington, DC, USA
| | - Kyle P Salka
- Pediatric Pulmonary and Sleep Medicine, Childrens National Medical Center, Washington, DC, USA
| | - Geovanny F Perez
- Department of Pulmonary, Children's National Health System, Washington, DC, USA
| | - Carlos E Rodriguez-Martinez
- Universidad Nacional de Colombia, Bogota, Colombia.,Universidad El Bosque Facultad de Medicina, Bogota, Colombia
| | | | - Gustavo Nino
- Childrens National Medical Center, Washington, DC, USA
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Stewart CJ, Hasegawa K, Wong MC, Ajami NJ, Petrosino JF, Piedra PA, Espinola JA, Tierney CN, Camargo CA, Mansbach JM. Respiratory Syncytial Virus and Rhinovirus Bronchiolitis Are Associated With Distinct Metabolic Pathways. J Infect Dis 2018; 217:1160-1169. [PMID: 29293990 PMCID: PMC5939849 DOI: 10.1093/infdis/jix680] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/22/2017] [Indexed: 11/12/2022] Open
Abstract
Background Bronchiolitis, the leading cause of hospitalization among infants in the United States, is most commonly caused by respiratory syncytial virus (RSV), followed by rhinovirus (RV). Conventional perception is that bronchiolitis is a single entity, albeit with different viral etiologies and degrees of severity. Methods We conducted a cross-sectional study of nasopharyngeal aspirates from 106 infants hospitalized with bronchiolitis due to either RSV only (80 patients) or RV only (26 patients). We performed metabolomics analysis and 16S ribosomal RNA gene sequencing on all samples and metagenomic sequencing on 58 of 106 samples. Results Infants with RSV-only and RV-only infections had significantly different nasopharyngeal metabolome profiles (P < .001) and bacterial metagenome profiles (P < .05). RSV-only infection was associated with metabolites from a range of pathways and with a microbiome dominated by Streptococcus pneumoniae. By contrast, RV-only infection was associated with increased levels of essential and nonessential N-acetyl amino acids and with a high relative abundance of Haemophilus influenzae. These co-occurring species were associated with driving the bacterially derived metabolic pathways. Multi-omic analysis showed that both the virus and the microbiome were significantly associated with metabolic function in infants hospitalized with bronchiolitis. Conclusion Although replication of these findings is necessary, they highlight that bronchiolitis is not a uniform disease between RSV and RV infections, a result with future implications for prevention and treatment.
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Affiliation(s)
- Christopher J Stewart
- Alkek Center for Metagenomics and Microbiome Research, Houston, Texas
- Department of Molecular Virology and Microbiology, Houston, Texas
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Matthew C Wong
- Alkek Center for Metagenomics and Microbiome Research, Houston, Texas
- Department of Molecular Virology and Microbiology, Houston, Texas
| | - Nadim J Ajami
- Alkek Center for Metagenomics and Microbiome Research, Houston, Texas
- Department of Molecular Virology and Microbiology, Houston, Texas
| | - Joseph F Petrosino
- Alkek Center for Metagenomics and Microbiome Research, Houston, Texas
- Department of Molecular Virology and Microbiology, Houston, Texas
| | - Pedro A Piedra
- Department of Molecular Virology and Microbiology, Houston, Texas
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Janice A Espinola
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Courtney N Tierney
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan M Mansbach
- Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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An J, Lee KS, Kim JT, Yang HJ, Cho YS, Jang KC, Song WJ, Kwon HS, Yoon JS, Han MY. A Delphi approach to the development of standard questionnaire to investigate asthma in Koreans. ALLERGY ASTHMA & RESPIRATORY DISEASE 2018. [DOI: 10.4168/aard.2018.6.1.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jaewoo An
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Kyung Suk Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jin Tack Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon-Jong Yang
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - You Sook Cho
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kwang Cheon Jang
- Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyouk-Soo Kwon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Seo Yoon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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7
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Rinawi F, Kassis I, Tamir R, Kugelman A, Srugo I, Miron D. Bronchiolitis in young infants: is it a risk factor for recurrent wheezing in childhood? World J Pediatr 2017; 13:41-48. [PMID: 27650524 DOI: 10.1007/s12519-016-0056-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 06/09/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute bronchiolitis in infancy is considered a risk factor for recurrent wheezing episodes in childhood. The present study assessed prevalence, clinical manifestations and risk factors for recurrent wheezing events during the first 3 years of life and persistent wheezing events beyond this age in children hospitalized as young infants with acute bronchiolitis. METHODS Two groups of children aged 6 years were included. The study group comprised 150 children with a history of hospitalization for bronchiolitis, with the first event at <6 months of age. The control group comprised 66 age- and sex-matched children with no history of bronchiolitis before 6 months of age. Children in both groups had been followed until 6 years of age by their pediatricians; data were obtained retrospectively by reviewing ambulatory records during children's visits in pediatricians' clinics. The data included epidemiological parameters, prevalence, age at onset, number of and treatments given for episodes of wheezing events prior to 6 years of age, pathogens detected, and severity of acute bronchiolitis in the study group. RESULTS Overall, 58% and 27% of children in the study and control groups, respectively (P=0.001) had recurrent wheezing episodes prior to the age of 3 years. Children in the study group had earlier onset of recurrent wheezing, had more episodes of wheezing, and required more bronchodilator and systemic steroids treatments compared to the control group. CONCLUSION Hospitalization within the first six months of life for acute bronchiolitis is an independent risk factor for recurrent wheezing episodes during the first 3 years of life.
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Affiliation(s)
- Firas Rinawi
- Pediatric Department A', HaEmeq Medical Center, POB 10535, 16100, Afula, Israel.
| | - Imad Kassis
- Pediatric Infectious Disease unit, Meyer Children Hospital, Haifa, Israel.,The Ruth and Bruce Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Rina Tamir
- The Ruth and Bruce Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Amir Kugelman
- The Ruth and Bruce Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Pediatric Department, Bnai Zion Medical Center, Haifa, Israel
| | - Isaac Srugo
- The Ruth and Bruce Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Pediatric Department, Bnai Zion Medical Center, Haifa, Israel
| | - Dan Miron
- The Ruth and Bruce Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Pediatric Infectious Disease Consultation Service, HaEmeq Medical Center, Afula, Israel
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Ozdemir A, Dogruel D, Yilmaz O. Vitamin D Status in Infants with Two Different Wheezing Phenotypes. Indian J Pediatr 2016; 83:1386-1391. [PMID: 27345567 DOI: 10.1007/s12098-016-2184-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/13/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate vitamin D levels in patients with recurrent wheeze at early ages of childhood. METHODS In the present cross-sectional study, serum 25-hydroxy vitamin D [25 (OH)D], levels which is known as an indicator of vitamin D adequacy, was examined in infants with three or more wheezing attacks. RESULTS A total of 186 infants with recurrent wheezing were included in the study along with 118 healthy control peers. The recurrent wheezing study participants were classified into two groups according to Asthma Predictive Index (API) positivity and compared to control subjects regarding their serum vitamin D status. The API negative group had the lowest mean serum 25 (OH)D level (n = 121; 22.71 ± 10.76 ng/ml) followed by API positive group (n = 65; 24.08 ± 9.02 ng/ml) compared to healthy group (26.24 ± 11.88 ng/ml) (p < 0.05). In addition, higher vitamin D deficiency was observed in infants in API negative group (52.1 %; p < 0.01) and API positive group (38.5 %; p < 0.05) than control group (31.4 %). CONCLUSIONS Low levels of 25 (OH)D were detected in infants with two different phenotypes of recurrent wheeze. Vitamin D deficiency may play a role in the pathogenesis of infants with recurrent wheezing.
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Affiliation(s)
- Ali Ozdemir
- Pediatric Pulmonary Section, Department of Pediatrics, Mersin Children's Hospital, Halkkent, 33240, Mersin, Turkey.
| | - Dilek Dogruel
- Pediatric Allergy & Immunology Section, Department of Pediatrics, University of Baskent, Adana, Turkey
| | - Ozlem Yilmaz
- Pediatric Allergy & Immunology Section, Department of Pediatrics, Mersin Children's Hospital, Halkkent, Mersin, Turkey
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Luo G, Nkoy FL, Stone BL, Schmick D, Johnson MD. A systematic review of predictive models for asthma development in children. BMC Med Inform Decis Mak 2015; 15:99. [PMID: 26615519 PMCID: PMC4662818 DOI: 10.1186/s12911-015-0224-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 11/26/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Asthma is the most common pediatric chronic disease affecting 9.6 % of American children. Delay in asthma diagnosis is prevalent, resulting in suboptimal asthma management. To help avoid delay in asthma diagnosis and advance asthma prevention research, researchers have proposed various models to predict asthma development in children. This paper reviews these models. METHODS A systematic review was conducted through searching in PubMed, EMBASE, CINAHL, Scopus, the Cochrane Library, the ACM Digital Library, IEEE Xplore, and OpenGrey up to June 3, 2015. The literature on predictive models for asthma development in children was retrieved, with search results limited to human subjects and children (birth to 18 years). Two independent reviewers screened the literature, performed data extraction, and assessed article quality. RESULTS The literature search returned 13,101 references in total. After manual review, 32 of these references were determined to be relevant and are discussed in the paper. We identify several limitations of existing predictive models for asthma development in children, and provide preliminary thoughts on how to address these limitations. CONCLUSIONS Existing predictive models for asthma development in children have inadequate accuracy. Efforts to improve these models' performance are needed, but are limited by a lack of a gold standard for asthma development in children.
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Affiliation(s)
- Gang Luo
- Department of Biomedical Informatics, University of Utah, Suite 140, 421 Wakara Way, Salt Lake City, UT 84108 USA
| | - Flory L. Nkoy
- Department of Pediatrics, University of Utah, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113 USA
| | - Bryan L. Stone
- Department of Pediatrics, University of Utah, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113 USA
| | - Darell Schmick
- Spencer S. Eccles Health Sciences Library, 10 N 1900 E, Salt Lake City, UT 84112 USA
| | - Michael D. Johnson
- Department of Pediatrics, University of Utah, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113 USA
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Luo G. MLBCD: a machine learning tool for big clinical data. Health Inf Sci Syst 2015; 3:3. [PMID: 26417431 PMCID: PMC4584489 DOI: 10.1186/s13755-015-0011-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/22/2015] [Indexed: 12/12/2022] Open
Abstract
Background Predictive modeling is fundamental for extracting value from large clinical data sets, or “big clinical data,” advancing clinical research, and improving healthcare. Machine learning is a powerful approach to predictive modeling. Two factors make machine learning challenging for healthcare researchers. First, before training a machine learning model, the values of one or more model parameters called hyper-parameters must typically be specified. Due to their inexperience with machine learning, it is hard for healthcare researchers to choose an appropriate algorithm and hyper-parameter values. Second, many clinical data are stored in a special format. These data must be iteratively transformed into the relational table format before conducting predictive modeling. This transformation is time-consuming and requires computing expertise. Methods This paper presents our vision for and design of MLBCD (Machine Learning for Big Clinical Data), a new software system aiming to address these challenges and facilitate building machine learning predictive models using big clinical data. Results The paper describes MLBCD’s design in detail. Conclusions By making machine learning accessible to healthcare researchers, MLBCD will open the use of big clinical data and increase the ability to foster biomedical discovery and improve care.
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Affiliation(s)
- Gang Luo
- Department of Biomedical Informatics, University of Utah, Suite 140, 421 Wakara Way, Salt Lake City, UT 84108 USA
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11
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Low serum 25-hydroxyvitamin D levels and bronchiolitis severity in Spanish infants. Eur J Pediatr 2015; 174:365-72. [PMID: 25178896 DOI: 10.1007/s00431-014-2405-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 08/12/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED This cross-sectional study was performed to examine the prevalence of hypovitaminosis D in infants with acute bronchiolitis compared with control subjects and to evaluate the relationship between serum 25-hydroxyvitamin D (25(OH) D) and the severity of bronchiolitis. Serum 25(OH) D levels were measured by radioimmunoassay in 48 infants with acute bronchiolitis (2.5 ± 2.0 months) and in 30 healthy infants (3.2 ± 2.3 months). 25(OH) D levels (ng/ml) in children with acute bronchiolitis were significantly lower than in the control group (median 29.9 ng/ml (interquartile range (IQR) 21.4-37.5) versus median 38.2 ng/ml ((IQR 26.1-48.1), p = 0.022), mainly in infants with moderate-severe bronchiolitis (median 29.8 ng/ml, IQR 19.2-35.9). The prevalence of hypovitaminosis D was remarkably greater among infants with bronchiolitis than in control subjects (52.1 versus 26.6%). A significant inverse correlation was found between serum 25-hydroxyvitamin D levels and disease severity (rho = -0.457, p < 0.001). CONCLUSION The prevalence of hypovitaminosis D is high in Spanish infants with bronchiolitis. The severity of acute bronchiolitis increases with a decline in serum 25 (OH) D level.
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12
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Midulla F, Nicolai A, Ferrara M, Gentile F, Pierangeli A, Bonci E, Scagnolari C, Moretti C, Antonelli G, Papoff P. Recurrent wheezing 36 months after bronchiolitis is associated with rhinovirus infections and blood eosinophilia. Acta Paediatr 2014; 103:1094-9. [PMID: 24948158 PMCID: PMC7159785 DOI: 10.1111/apa.12720] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 04/29/2014] [Accepted: 06/16/2014] [Indexed: 02/06/2023]
Abstract
AIM Links between respiratory syncytial virus bronchiolitis and asthma are well known, but few studies have dealt with wheezing following bronchiolitis induced by other viruses. We assessed the risk factors for recurrent wheezing in infants hospitalised for acute viral bronchiolitis. METHODS We followed 313 infants for three years after they were hospitalised for bronchiolitis, caused by 14 different viruses, to identify risk factors for recurrent wheezing. Parents provided feedback on wheezing episodes during telephone interviews 12 (n = 266), 24 (n = 242) and 36 (n = 230) months after hospitalisation. RESULTS The frequency of wheezing episodes diminished during the follow-up period: 137 children (51.7%) at 12 months, 117 (48.3%) at 24 months and 93 (40.4%) at 36 months. The risk of wheeze after three years was OR = 7.2 (95% CI 3.9-13.3) if they had episodes of wheezing during the first year after bronchiolitis, 16.8 (8.7-32.7) if they had episodes of wheezing during the second year and 55.0 (22.7-133.2) if they wheezed during both years. Blood eosinophils >400 cells/μL (OR 7.7; CI 1.4-41.8) and rhinovirus infections (3.1; 1.0-9.4) were the major risk factors for recurrent wheezing. CONCLUSION Recurrent wheezing 36 months after infant bronchiolitis was associated with rhinoviruses and blood eosinophilia.
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Affiliation(s)
- Fabio Midulla
- Department of Paediatrics; Sapienza University; Rome Italy
| | - Ambra Nicolai
- Department of Paediatrics; Sapienza University; Rome Italy
| | | | | | - Alessandra Pierangeli
- Virology Laboratory; Department of Molecular Medicine; Sapienza University; Rome Italy
| | - Enea Bonci
- Department of Experimental Medicine; Sapienza University; Rome Italy
| | - Carolina Scagnolari
- Virology Laboratory; Department of Molecular Medicine; Sapienza University; Rome Italy
| | | | - Guido Antonelli
- Virology Laboratory; Department of Molecular Medicine; Sapienza University; Rome Italy
| | - Paola Papoff
- Department of Paediatrics; Sapienza University; Rome Italy
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Gidaris D, Urquhart D, Anthracopoulos MB. 'They said it was bronchiolitis; is it going to turn into asthma doctor?'. Respirology 2014; 19:1158-64. [PMID: 25138566 DOI: 10.1111/resp.12371] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 05/26/2014] [Accepted: 07/15/2014] [Indexed: 12/14/2022]
Abstract
Acute bronchiolitis is a common paediatric disease of infancy. Its association with subsequent asthma development has puzzled clinicians and epidemiologists for decades. This article reviews the current state of knowledge regarding the role of acute bronchiolitis in the inception of asthma. There is little doubt that acute bronchiolitis is associated with an increased risk of recurrent wheezing throughout the primary school years although the direction of causality--i.e. whether bronchiolitis in infancy leads to asthma or it merely represents the first clinical presentation of predisposition to asthma--is uncertain. Existing evidence suggests that both host factors (e.g. prematurity, atopic predisposition) and acute viral infection characteristics (e.g. type of virus, severity) are operating in this relationship, perhaps with variable involvement in different individuals. Further clarification of these issues will help paediatricians provide evidence-based information regarding the long-term prognosis of this common disease to the families, and at the same time, it will facilitate prophylactic approaches and therapeutic strategies.
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Affiliation(s)
- Dimos Gidaris
- 1st Paediatric Department, Aristotle University of Thessaloniki, Hippokrateion General Hospital, Thessaloniki, Greece
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14
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A systematic review of predictive modeling for bronchiolitis. Int J Med Inform 2014; 83:691-714. [PMID: 25106933 DOI: 10.1016/j.ijmedinf.2014.07.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 06/20/2014] [Accepted: 07/16/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE Bronchiolitis is the most common cause of illness leading to hospitalization in young children. At present, many bronchiolitis management decisions are made subjectively, leading to significant practice variation among hospitals and physicians caring for children with bronchiolitis. To standardize care for bronchiolitis, researchers have proposed various models to predict the disease course to help determine a proper management plan. This paper reviews the existing state of the art of predictive modeling for bronchiolitis. Predictive modeling for respiratory syncytial virus (RSV) infection is covered whenever appropriate, as RSV accounts for about 70% of bronchiolitis cases. METHODS A systematic review was conducted through a PubMed search up to April 25, 2014. The literature on predictive modeling for bronchiolitis was retrieved using a comprehensive search query, which was developed through an iterative process. Search results were limited to human subjects, the English language, and children (birth to 18 years). RESULTS The literature search returned 2312 references in total. After manual review, 168 of these references were determined to be relevant and are discussed in this paper. We identify several limitations and open problems in predictive modeling for bronchiolitis, and provide some preliminary thoughts on how to address them, with the hope to stimulate future research in this domain. CONCLUSIONS Many problems remain open in predictive modeling for bronchiolitis. Future studies will need to address them to achieve optimal predictive models.
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Hasegawa K, Mansbach JM, Camargo CA. Infectious pathogens and bronchiolitis outcomes. Expert Rev Anti Infect Ther 2014; 12:817-28. [PMID: 24702592 DOI: 10.1586/14787210.2014.906901] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bronchiolitis is a common early childhood illness and an important cause of morbidity, it is the number one cause of hospitalization among US infants. Bronchiolitis is also an active area of research, and recent studies have advanced our understanding of this illness. Although it has long been the conventional wisdom that the infectious etiology of bronchiolitis does not affect outcomes, a growing number of studies have linked specific pathogens of bronchiolitis (e.g., rhinovirus) to short- and long-term outcomes, such as future risk of developing asthma. The authors review the advent of molecular diagnostic techniques that have demonstrated diverse pathogens in bronchiolitis, and they review recent studies on the complex link between infectious pathogens of bronchiolitis and the development of childhood asthma.
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Affiliation(s)
- Kohei Hasegawa
- Department of Emergency Medicine (KH, CAC), Boston, MA, USA
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16
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Nantanda R, Tumwine JK, Ndeezi G, Ostergaard MS. Asthma and pneumonia among children less than five years with acute respiratory symptoms in Mulago Hospital, Uganda: evidence of under-diagnosis of asthma. PLoS One 2013; 8:e81562. [PMID: 24312321 PMCID: PMC3843700 DOI: 10.1371/journal.pone.0081562] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 10/14/2013] [Indexed: 11/21/2022] Open
Abstract
Background Pneumonia is considered the major cause of mortality among children with acute respiratory disease in low-income countries but may be over-diagnosed at the cost of under-diagnosing asthma. We report the magnitude of asthma and pneumonia among “under-fives” with cough and difficulty breathing, based on stringent clinical criteria. We also describe the treatment for children with acute respiratory symptoms in Mulago Hospital. Methods We enrolled 614 children aged 2–59 months with cough and difficulty breathing. Interviews, physical examination, blood and radiological investigations were done. We defined asthma according to Global Initiative for Asthma guidelines. Pneumonia was defined according to World Health Organization guidelines, which were modified by including fever and white cell count, C-reactive protein, blood culture and chest x-ray. Children with asthma or bronchiolitis were collectively referred to as “asthma syndrome” due to challenges of differentiating the two conditions in young children. Three pediatricians reviewed each participant’s case report post hoc and made a diagnosis according to the study criteria. Results Of the 614 children, 41.2% (95% CI: 37.3–45.2) had asthma syndrome, 27.2% (95% CI: 23.7–30.9) had bacterial pneumonia, 26.5% (95% CI: 23.1–30.2) had viral pneumonia, while 5.1% (95% CI: 3.5–7.1) had other diagnoses including tuberculosis. Only 9.5% of the children with asthma syndrome had been previously diagnosed as asthma. Of the 253 children with asthma syndrome, 95.3% (95% CI: 91.9–97.5) had a prescription for antibiotics, 87.7% (95% CI: 83.1–91.5) for bronchodilators and 43.1% (95% CI: 36.9–49.4) for steroids. Conclusion Although reports indicate that acute respiratory symptoms in children are predominantly due to pneumonia, asthma syndrome contributes a significant proportion. Antibiotics are used irrationally due to misdiagnosis of asthma as pneumonia. There is need for better diagnostic tools for childhood asthma and pneumonia in Uganda.
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Affiliation(s)
- Rebecca Nantanda
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
- * E-mail:
| | - James K. Tumwine
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Marianne S. Ostergaard
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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McCallum GB, Morris PS, Chatfield MD, Maclennan C, White AV, Sloots TP, Mackay IM, Chang AB. A single dose of azithromycin does not improve clinical outcomes of children hospitalised with bronchiolitis: a randomised, placebo-controlled trial. PLoS One 2013; 8:e74316. [PMID: 24086334 PMCID: PMC3783434 DOI: 10.1371/journal.pone.0074316] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 07/30/2013] [Indexed: 11/25/2022] Open
Abstract
Objective Bronchiolitis, one of the most common reasons for hospitalisation in young children, is particularly problematic in Indigenous children. Macrolides may be beneficial in settings where children have high rates of nasopharyngeal bacterial carriage and frequent prolonged illness. The aim of our double-blind placebo-controlled randomised trial was to determine if a large single dose of azithromycin (compared to placebo) reduced length of stay (LOS), duration of oxygen (O2) and respiratory readmissions within 6 months of children hospitalised with bronchiolitis. We also determined the effect of azithromycin on nasopharyngeal microbiology. Methods Children aged ≤18 months were randomised to receive a single large dose (30 mg/kg) of either azithromycin or placebo within 24 hrs of hospitalisation. Nasopharyngeal swabs were collected at baseline and 48hrs later. Primary endpoints (LOS, O2) were monitored every 12 hrs. Hospitalised respiratory readmissions 6-months post discharge was collected. Results 97 children were randomised (n = 50 azithromycin, n = 47 placebo). Median LOS was similar in both groups; azithromycin = 54 hours, placebo = 58 hours (difference between groups of 4 hours 95%CI -8, 13, p = 0.6). O2 requirement was not significantly different between groups; Azithromycin = 35 hrs; placebo = 42 hrs (difference 7 hours, 95%CI -9, 13, p = 0.7). Number of children re-hospitalised was similar 10 per group (OR = 0.9, 95%CI 0.3, 2, p = 0.8). At least one virus was detected in 74% of children. The azithromycin group had reduced nasopharyngeal bacterial carriage (p = 0.01) but no difference in viral detection at 48 hours. Conclusion Although a single dose of azithromycin reduces carriage of bacteria, it is unlikely to be beneficial in reducing LOS, duration of O2 requirement or readmissions in children hospitalised with bronchiolitis. It remains uncertain if an earlier and/or longer duration of azithromycin improves clinical and microbiological outcomes for children. The trial was registered with the Australian and New Zealand Clinical Trials Register. Clinical trials number: ACTRN12608000150347. http://www.anzctr.org.au/TrialSearch.aspx.
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Affiliation(s)
- Gabrielle B. McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- * E-mail:
| | - Peter S. Morris
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Mark D. Chatfield
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Carolyn Maclennan
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Andrew V. White
- Department of Paediatrics, The Townsville Hospital, Townsville, Queensland, Australia
| | - Theo P. Sloots
- Queensland Paediatric Infectious Diseases Laboratory, Sir Albert Sakzewski Virus Research Centre, Queensland Children's Medical Research Institute, Children's Health Queensland Hospital and Health Service, The University of Queensland, Brisbane, Australia
| | - Ian M. Mackay
- Queensland Paediatric Infectious Diseases Laboratory, Sir Albert Sakzewski Virus Research Centre, Queensland Children's Medical Research Institute, Children's Health Queensland Hospital and Health Service, The University of Queensland, Brisbane, Australia
| | - Anne B. Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, Queensland, Queensland University of Technology, Kelvin Grove, Australia
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Respiratory morbidity of preterm infants of less than 33 weeks gestation without bronchopulmonary dysplasia: a 12-month follow-up of the CASTOR study cohort. Epidemiol Infect 2013; 142:1362-74. [PMID: 24029023 PMCID: PMC9151199 DOI: 10.1017/s0950268813001738] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The aim of this study was to describe the incidence and risk factors for respiratory morbidity during the 12-month period following the first respiratory syncytial virus (RSV) season in 242 preterm infants [<33 weeks gestational age (GA)] without bronchopulmonary dysplasia and 201 full-term infants (39-41 weeks GA) from the French CASTOR study cohort. Preterm infants had increased respiratory morbidity during the follow-up period compared to full-terms; they were more likely to have wheezing (21% vs. 11%, P = 0·007) and recurrent wheezing episodes (4% vs. 1%, P = 0·049). The 17 infants (14 preterms, three full-terms) who had been hospitalized for RSV-confirmed bronchiolitis during their first RSV season had significantly more wheezing episodes during the follow-up period than subjects who had not been hospitalized for RSV-confirmed bronchiolitis (odds ratio 4·72, 95% confidence interval 1·71-13·08, P = 0·003). Male gender, birth weight <3330 g and hospitalization for RSV bronchiolitis during the infant's first RSV season were independent risk factors for the development of wheezing episodes during the subsequent 12-month follow-up period.
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Mikalsen IB, Halvorsen T, Eide GE, Øymar K. Severe bronchiolitis in infancy: can asthma in adolescence be predicted? Pediatr Pulmonol 2013; 48:538-44. [PMID: 22976850 DOI: 10.1002/ppul.22675] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 06/18/2012] [Indexed: 01/26/2023]
Abstract
Bronchiolitis in infancy is a risk factor for development of asthma in the first decades of life, although the majority may be asymptomatic at school age. Respiratory symptoms are common in early life, and prediction of later asthma may be challenging. We aimed to study if simple clinical variables assessed at 2 years of age could predict asthma at 11 years of age and thereby provide a basis for follow-up and treatment after bronchiolitis in infancy. The study included 105 children hospitalized for bronchiolitis during their first year of life. Of these, 101 (96.2%) participated in the first follow-up at 2 years of age and 93 (88.6%) in the second follow-up at age 11. The overall prevalence of asthma at 11 years of age was 22.6%. Among the risk factors assessed at 2 years of age, recurrent wheeze appeared most important (odds ratio for later asthma: 7.2; 95% confidence interval: 1.3, 41.6; P = 0.015). Tested separately, recurrent wheeze had high sensitivity (90.5%), but low specificity (58.3%), low negative likelihood ratio (LR) (0.2) and low negative post-test probability (4.5%); indicating that absence of recurrent wheeze was better suited to exclude than to predict asthma at 11 years of age. Combining recurrent wheeze with either parental atopy, parental asthma or atopic dermatitis improved the specificity (>80), positive LR (>3) and positive post-test probability (∼50%), rendering the combinations more appropriate for the prediction of later asthma. In conclusion, after bronchiolitis in infancy, simple clinical non-invasive variables assessed at 2 years of age could predict asthma at 11 years of age with reasonable accuracy. However, the data were better suited to exclude than to predict later asthma.
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Lin HW, Lin SC. Environmental factors association between asthma and acute bronchiolitis in young children--a perspective cohort study. Eur J Pediatr 2012; 171:1645-50. [PMID: 22777642 DOI: 10.1007/s00431-012-1788-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 06/23/2012] [Indexed: 01/27/2023]
Abstract
Acute bronchiolitis and asthma are respiratory tract diseases of childhood that are characterized by wheezing. However, the diagnosis of asthma is difficult in patients younger than 2 years. We evaluated the association between asthma or acute bronchiolitis and various risk factors in young children. This perspective cohort study included a study group of children younger than 2 years with a recorded diagnosis of acute bronchiolitis (N = 4,586) as well as a control group (N = 4,263). Children in both groups were registered between January 1, 2004 and December 31, 2004, on the Taiwan Longitudinal Health Insurance Database (2005), and each child was followed in our study until December 31, 2006, using data from the same source. Of the 8,849 children in our study, 355 experienced asthma during the 3-year follow-up period. Among these 355 asthma patients, 332 children (29.1 per 1,000 person-years, 95% CI 26.2-36.4) belonged to the acute bronchiolitis cohort and 23 children (2.0 per 1,000 person-years, 95% CI 13.3-29.9) belonged to the comparison cohort. Cox proportional hazard regression analysis showed that children with acute bronchiolitis were more likely to have asthma than the control population, after adjustment for potential confounders (adjusted hazard ratio [HR] 13.55, 95% CI 8.87-20.71). Boys with acute bronchiolitis had a higher HR for asthma than girls during the 3-year follow-up. Children with acute bronchiolitis who lived in rural areas had a 1.49 HR for asthma compared with their urban counterparts. Children living in the northern region of Taiwan had a higher HR ratio than those in other regions. Sex, urbanization, and geographic region all showed significant associations with acute bronchiolitis and asthma. Based on the asthma-free survival curves of Kaplan-Meier analysis in our study, young children with acute bronchiolitis should be monitored for 2 years to prevent them from developing asthma. This was the first study to evaluate the length of time for which acute bronchiolitis poses a risk for the development of asthma in young children.
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Affiliation(s)
- Hui-Wen Lin
- Department of Mathematics, Soochow University, Taipei, Taiwan
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