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Bronchiolitis and Pneumonia in Infancy – Asthma, Lung Function and Quality of Life at a 30-Year Follow-Up

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Bronchiolitis and Pneumonia in Infancy – Asthma, Lung Function and Quality of Life at a 30-Year Follow-Up Bronchiolitis and pneumonia in infancy – asthma, lung function and quality of life at a 30-year follow-up KATRI BACKMAN1,2, EIJA PIIPPO-SAVOLAINEN1, HERTTA OLLIKAINEN2, HEIKKI KOSKELA3 AND MATTI KORPPI4 SUMMARY Bronchiolitis and pneumonia in ronchiolitis is an acute, viral, symptoms resolve by the age of 6 infancy have been associated lower respiratory tract infec- years (7). However, some children, with respiratory morbidity, tion (LRTI) presenting in early with wheezing before the age of 3 lung function impairment and B childhood (1). It is usually defined years, continue to wheeze and lower health-related quality of as the first wheezing episode in the develop asthma later in childhood. life (HRQoL) in later life. The aim of the present study was to childhood (2). It is a disease with high So, in some children early wheezing study 30-year sequelae of morbidity, since about 30–40 % of may be the first sign of respiratory bronchiolitis and pneumonia in children develop bronchiolitis before morbidity such as asthma (7). infancy. In 1981–1982, 83 the 2 years of age (1). There is There is evidence that LRTIs like children were hospitalized for evidence that respiratory syncytial bronchiolitis and pneumonia in bronchiolitis and 44 for virus (RSV) is the predominant virus infancy are associated with increased pneumonia at Kuopio associated with bronchiolitis and risk of lung function disorders, such University Hospital at less than pneumonia in young children (3, 4). as asthma and chronic obstructive 2 years of age. In 2010, 48 However in older age groups the role pulmonary disease (COPD), even in (58%) bronchiolitis and 22 of other viruses, especially rhinovrus- adulthood (8–10). In two post-bron- (50%) pneumonia patients and es, becomes more pronounced (5). chiolitis follow-up studies impaired 138 controls attended the clinical study. Asthma was The link between early childhood lung function was demonstrated at defined as doctor-diagnosed or respiratory infections and later the age of 17–20 years in former self-reported asthma as an respiratory morbidity has been an bronchiolitis patients (9, 10). However indicator of the certainty of the issue of interest during recent there are no prospective post-bron- diagnosis. Participants decades, and an association between chiolitis studies including longer completed St. George´s lower respiratory tract infections follow-up than this. Respiratory Questionnaire as a (LRTI) in early childhood and later There are only a few studies HRQoL tool and underwent respiratory morbidity even in adult- describing health-related quality of pre-bronchodilatation (pre-BD) hood has been well established (6). life (HRQoL) after early childhood and post-BD spirometry. In 60 % of wheezing infants tendency LRTIs. In line with impaired lung Doctor-diagnosed asthma was to wheeze is a self-improving condi- function, also impaired HRQoL significantly more common in bronchiolitis patients (31%) tion (7). These transient wheezers has been described after LRTI´s compared to controls (9%). form a group of children, who have in infancy, but so far these studies Self-reported asthma was also wheezing symptoms at early age have not continued beyond child- significantly more common in during viral infections, but the hood (11, 12). bronchiolitis group (35%) compared to controls (15%). Asthma figures were similar in 1 Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland the former pneumonia patients 2 Department of Pediatrics, University of Eastern Finland, Kuopio, Finland and in controls. In addition, 3 Center of Medicine and Clinical Research, Division of Pulmonology, Kuopio University Hospital, hospitalization for bronchiolitis Kuopio, Finland 4 Pediatric Research Centre, Tampere University and Tampere University Hospital, or pneumonia in infancy was Tampere, Finland associated with an impaired HRQoL and irreversible corresponding author: Katri Backman, MD obstructive lung function Department of Pediatrics, University of Eastern Finland impairment in adulthood. P.O. Box 1627, FI-70211 Kuopio [email protected] 40 ALLERGI I PRAKXSIS 1/2015 Bronchiolitis and pneumonia in infancy – asthma, lung function and quality of life at a 30-year follow-up Bronchiolitis is an acute, viral, lower respiratory tract infection presenting in early childhood. It is a disease with high morbidity, since about 30–40 % of children develop bronchiolitis before the 2 years of age. PHOTO: COLOURBOX.COM We have followed a group of patients after bronchiolitis and pneumonia in hospitalized for bronchiolitis or pneu- infancy. We also studied whether Methods monia in early childhood in 1981–82, permanently reduced lung function, In 1981–1982 127 children, hospital- and found an increased risk of both irreversible obstruction in particular, ized for LRTI in Kuopio University asthma and lung function disorders up is present in young adults after severe Hospital, Department of Pediatrics to the age of 18–20 years (10). In the LRTI in infancy. If so, LRTI in early at less than 2 years of age, were present study, at the age of 28–31 childhood could predispose infants enrolled in the study (13). Among the years, our aim was to evaluate asthma even to chronic obstructive pulmonary 127 recruited children with LRTI, 83 prevalence and HRQoL in adulthood disease (COPD) in adulthood. were diagnosed with bronchiolitis and A ALLERGI I PRAKXSIS 1/2015 41 44 with pneumonia. The cohort has breathlessness), and the impact use of bronchodilators was required. been followed-up since, until the age scores (social or psychological Cases with doctor-diagnosed asthma of 18–20 years (10, 14, 15). disturbances resulting from airway were included (16). In 2010, 48 (58 %) former bronchiol- disease). The scores are expressed PEF was measured using a Mini itis and 22 (50 %) former pneumonia as a percentage of complete impair- Wright PEF meter (Clement-Clarke patients and 138 population controls ment; thus, the score 100 means International LTD, Harlow, Essex UK) attended the clinical study, which the worst possible and the score 0 three times every morning and every consisted of an examination by a the best possible respiratory health evening for two weeks (18). Daily doctor , spirometry including both status (17). variability over 20 % between the PEF pre-BD and post-BD measurements, Bronchial asthma was defined morning and evening values or PEF and monitoring two-week home in two different ways, reflecting improvement of 15 % or more after peak expiratory flow (PEF) (16). the certainty of the diagnosis. bronchodilator inhalation for two The study subjects completed a For doctor-diagnosed asthma, or more days were considered as questionnaire including questions an on-going regular maintenance abnormal (16,19). for example about asthma symptoms medication for asthma and a previ- Skin prick test (SPTs) (ALK Solu- and the presence of previous doctor- ously settled asthma diagnosis were prick®, Copenhagen, Denmark) diagnosed asthma and smoking required. In addition, study subjects included the most common inhaled status (16). Participants also com- who reported asthma symptoms allergens. Clinical atopy was defined pleted the St. George’s Respiratory and/or repeated use of bronchodila- by the presence of allergic rhinitis, Questionnaire (SGRQ), designed tors, and in addition had a patho- allergic conjunctivitis or atopic to measure HRQoL in adults with logical result in the home PEF eczema, combined with one or more asthma or COPD (17). SGRQ consists monitoring, were regarded to positive SPT results. of three parts: symptom scores (the have doctor-diagnosed asthma. Lung function was measured with frequency and severity of respiratory For self-reported asthma, previously a Medikro SpiroStar USB spirometer symptoms), the activity scores (the diagnosed asthma combined with (Medikro, Kuopio, Finland) using Spiro activities that are limited due to asthma symptoms or with repeated 2000, Software version 2.2., according to international standards before TABLE 1. The scores calculated from the St. George’s Respiratory (pre-BD) and after (post-BD) broncho- Questionnaire at the age of 28–31 years in the three study groups. dilatation (18, 20). The measured BRONCHIOLITIS N=48 PNEUMONIA N=22 CONTROL N=138 indices were forced vital capacity SGRQ MEDIAN MEDIAN MEDIAN (FVC) and forced expiratory volume P – VALUE2 P – VALUE2 COMPONENTS IQ1 25–75 IQ1 25–75 IQ1 25–75 in one second (FEV1) and FEV1/FVC 9.1 18.4 0.005 5.0 Symptom score 0.044 and the results were presented as 0.0–26.3 5.1–29.9 0.0–16.3 percentages of the means of age- 5.7 0.0 0.146 0.0 Activity Score 0.002 0.0–12.1 0.0–13.4 0.0 – 6.0 and sex-specific, height-related reference values (FVC %, FEV1 %, 2.4 0.0 0.475 0.0 Impact Score < 0.001 0.0–9.5 0.0–8.4 0.0 – 2.4 FEV1/FVC %) (21). 5.4 4.9 0.012 1.5 Total Score < 0.001 0.0–14.7 1.3–14.8 0.0 – 6.0 Statistics The data was analyzed by using SPSS FIGURE 1. Asthma by two definitions at the age of 28–31 years in the study subjects 19.0 software (SPSS Inc., Chicago, IL, hospitalized40 for bronchiolitis or pneumonia at less than 24 months of age, compared with USA). Chi-square test and logistic 1 population controls. p =0.003 regression were used in the analyses p1=0.002 35% of the categorized asthma data. The 40 30 s 31% p1=0.003 Mann-Whitney U-test was used in the oup p2=0.760 analysis of the continuous SGRQ p1=0.002 35% scores. Analysis of variance (ANOVA) 0 30 23% s 31% adjusted for asthma and current daily oup p2=0.760 smoking was used in the analysis of % of study gr 0 2 23% 15% continuous lung function data and 02 p =0.532 11% the results are given as means and 9% 95 % confidence intervals (95 %CI) % of study gr 2 15% 02 p =0.532 and p-values.
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