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Bronchiolitis: Age and Previous Wheezing Episodes Are Linked to Viral Etiology and Atopic Characteristics

Jartti, Tuomas MD*; Lehtinen, Pasi MD*; Vuorinen, Tytti MD; Ruuskanen, Olli MD*

The Pediatric Infectious Disease Journal: April 2009 - Volume 28 - Issue 4 - p 311-317
doi: 10.1097/INF.0b013e31818ee0c1
Original Studies

Background: Diagnostic criteria for bronchiolitis are variable.

Objective: To study how the risk factors for recurrent wheezing and asthma vary by different definitions of bronchiolitis.

Methods: Viral etiology and atopic characteristics were studied in 259 hospitalized wheezing children (median age, 14 months; range, 0–36 months). The data were analyzed according to age (<6, <12, <24 and <36 months) and whether they had a history or no history of a previous wheezing episode. Sixteen viruses were detected by conventional and molecular methods. Atopic characteristics included the presence of eczema, specific and total IgE responses, blood eosinophil count, and modified asthma predictive index.

Results: Evidence of respiratory virus infection was found in 93% of the cases and allergic sensitization in 26% of the cases. Rhinovirus infections and atopic characteristics (sensitization, blood eosinophil count, and modified asthma predictive index) increased by age and were significantly more common in children with recurrent wheezing episodes than in first-time wheezers in age categories of <24 and <36 months (P < 0.05 for all).

Conclusions: In children with bronchiolitis, 2 clinical factors, age and number of previous wheezing episodes, are linked to inflammatory (atopy-related factors) and virologic risk factors of asthma (rhinovirus-associated disease). According to current US and UK guidelines, bronchiolitis includes wheezing children <24 months of age. Our observations suggest that the clinical definition should include only children with their first episode of wheezing.

SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT.

From the Departments of *Pediatrics and †Virology, Turku University Hospital, Turku, Finland.

Accepted for publication September 23, 2008.

Supported by the Academy of Finland, the Finnish Cultural Foundation, the Turku University Foundation, the Foundation for Pediatric Research, and the Paulo Foundation.

Address for correspondence: Tuomas Jartti, MD, Department of Pediatrics, Turku University Hospital, P.O. Box 52. FIN-20520 Turku, Finland. E-mail: tuomas.jartti@utu.fi.

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© 2009 Lippincott Williams & Wilkins, Inc.