Acute viral bronchiolitis and risk of asthma in schoolchildren: analysis of a Brazilian newborn cohort<sup>,</sup>

Brandão, Heli V.; Vieira, Graciete O.; Vieira, Tatiana O.; Cruz, Álvaro A.; Guimarães, Armênio C.; Teles, Carlos; Camargos, Paulo; Cruz, Constança M.S.

doi:10.1016/j.jped.2016.08.004

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Original articles • J. Pediatr. (Rio J.) 93 (3) • May-Jun 2017 • https://doi.org/10.1016/j.jped.2016.08.004 copy

Acute viral bronchiolitis and risk of asthma in schoolchildren: analysis of a Brazilian newborn cohort^☆ ☆ Please cite this article as: Brandão HV, Vieira GO, Vieira TO, Cruz ÁA, Guimarães AC, Teles C, et al. Acute viral bronchiolitis and risk of asthma in schoolchildren: analysis of a Brazilian newborn cohort. J Pediatr (Rio J). 2017;93:223-9. ^,^☆☆ ☆☆ Study conducted at Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To verify whether the occurrence of acute viral bronchiolitis in the first year of life constitutes a risk factor for asthma at age 6 considering a parental history of asthma.

Methods:

Cross-sectional study in a cohort of live births. A standardized questionnaire of the International Study of Asthma and Allergies in Childhood was applied to the mothers to identify asthma in children at the age of 6 years. Acute viral bronchiolitis diagnosis was performed by maternal report of a medical diagnosis and/or presence of symptoms of coryza accompanied by cough, tachypnea, and dyspnea when participants were 3, 6, 9, and 12 months. Socioeconomic, environmental data, parental history of asthma, and data related to pregnancy were collected in the first 72 h of life of the newborn and in prospective home visits by trained interviewers. The association between acute viral bronchiolitis and asthma was evaluated by logistic regression analysis and potential modifier effect of parental history was verified by introducing an interaction term into the adjusted logistic regression model.

Results:

Prevalence of acute viral bronchiolitis in the first year of life was 68.6% (461). The occurrence of acute viral bronchiolitis was a risk factor for asthma at 6 years of age in children with parental history of asthma OR: 2.66, 95% CI (1.10-6.40), modifier effect p = 0.002. Parental history of asthma OR: 2.07, 95% CI (1.29-3.30) and male gender OR: 1.69, 95% CI, (1.06-2.69) were other identified risk factors for asthma.

Conclusion:

Acute viral bronchiolitis in the first year of life is a risk factor for asthma in children with parental history of asthma.

KEYWORDS
Asthma; Risk factors; Bronchiolitis viral; Child

Variables	n (%)	OR (95 CI%)	p ^a a χ2 test.
Gender
Male	336 (50.0)	1.79 (1.14-2.81)	0.010
Female	336 (50.0)

Birth weight (grams)
<2500	30 (4.5)	1.25 (0.40-3.37)	0.646
≥2500	642 (95.5)

Gestational age (weeks)
<37	28 (4.2)	0.46 (0.10-2.00)	0.295
≥37	644 (95.8)

Family income (minimum wages)
Up to 2	477 (71.0)	1.28 (0.77-2.12)	0.326
≥2	195 (29.0)

Maternal level of schooling (years of study)
Up to 8	202 (30.1)	0.88 (0.54-1.44)	0.634
>8	470 (69.9)

Parity
Primiparous	336 (50.0)	0.88 (0.56-1.36)	0.576
Multiparous	336 (50.0)

Exclusive breastfeeding 3rd month
Yes	248 (36.8)	0.93 (0.59-1.47)	0.760
No	424 (63)

Exclusive breastfeeding 4th month
Yes	137 (20.4)	1.08 (0.63-1.84)	0.773
No	535 (79.6)

Maternal smoking during pregnancy
Yes	20 (3.0)	2.13 (0.75-6.02)	0.142
No	652 (97.0)

People sleeping in the child's bedroom (individuals)
<4	641 (95.4)	2.71 (1.20-6.09)	0.012
≥4	31 (4.6)

Rooms in household (rooms)
<5	541 (80.5)	0.74 (0.44-1.26)	0.275
≥5	131 (19.5)

Attended daycare at 24 months
Yes	104 (15.5)	0.69 (0.35-1.34)	0.277
No	568 (84.5)

Dog or cat in the household
Yes	297 (44.2)	0.99 (0.77-1.27)	0.982
No	375 (55.8)

Truck traffic on the household street
Yes	341 (50.7)	1.02 (0.85-1.22)	0.814
No	331 (49.3)

Parental history of asthma
Yes	180 (26.8)	2.01 (1.27-3.17)	0.002
No	492 (73.2)

Variables	OR (95% CI)	p ^a a χ2 test.	Adjusted OR (95% CI)	p ^b b Multivariate logistic regression test adjusted for gender, AVB, parental history of asthma, number of people sleeping in the room with the child, maternal smoking during pregnancy.
Male gender	1.79 (1.14-2.81)	0.01	1.69 (1.06-2.69)	0.025
Bronchiolitis at 3 months	1.82 (1.00-3.38)	0.047	1.76 (0.95-3.27)	0.007
Bronchiolitis at 6 months	1.09 (0.63-1.86)	0.749	1.08 (0.62-1.86)	0.772
Bronchiolitis at 9 months	1.20 (0.68-2.10)	0.513	1.02 (0.57-1.82)	0.93
Bronchiolitis at 12 months	2.71 (1.49-4.91)	0.011	2.42 (1.31-4.46)	0.004
Bronchiolitis in the 1st year of life	1.31 (1.00-1.72)	0.028	1.59 (1.01-2.53)	0.04
Parental history of asthma	2.01 (1.27-3.17)	0.002	2.07 (1.29-3.30)	0.002
Number of people sleeping in the child's bedroom >4	2.71 (1.20-6.09)	0.012	2.31 (0.99-5.40)	0.051

AVB frequency	%	OR (95% CI)	p ^a a Chi-squared test.	Adjusted OR (95% CI)	p ^b b Multivariate logistic regression test adjusted for gender, AVB, parental history of asthma, number of people sleeping in the room with the child, maternal smoking during pregnancy.
1 episode	34.8	1.15 (0.73-1.81)	0.540	1.19 (0.75-1.89)	0.454
2 episodes	12.3	1.73 (0.96-3.12)	0.610	1.58 (0.87-2.88)	0.132
3 or more episodes	2.2	1.57 (0.43-5.69)	0.485	1.27 (0.33-4.83)	0.717

Variables	No parental history of asthma (n = 496)		Parental history of asthma (n = 176)		Modifier effect p-value^b b Modifier effect p-value - interaction test.
	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)
	Crude	Adjusted	Crude	Adjusted^a a Adjusted for gender, number of people sleeping in the room with the child, parental history of asthma, maternal smoking during pregnancy.
Bronchiolitis at 3 months	1.35 (0.57-3.17)	1.37 (0.58-3.23)	2.30 (0.93-5.71)	2.48 (0.94-6.52)	0.003
Bronchiolitis at 6 months	1.07 (0.54-2.11)	1.05 (0.53-2.09)	1.14 (0.47-2.78)	1.30 (0.51-3.34)	0.001
Bronchiolitis at 9 months	1.31 (0.64-2.66)	1.23 (0.60-2.53)	0.96 (0.38-2.43)	0.76 (0.28-2.05)	0.004
Bronchiolitis at 12 months	2.28 (1.03-5.06)	2.00 (0.88-4.55)	3.11 (1.21-8.03)	3.90 (1.36-11.11)	<0.001
Bronchiolitis in the 1st year	2.28 (1.03-5.06)	1.66 (1.10-6.40)	3.11 (1.21-8.00)	2.66 (1.10-6.40)	0.002

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E-mail: jped@jped.com.br

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[1] * Corresponding author. E-mail:helivb.fsa@gmail.com (H.V. Brandão).