RSV infection in infancy may increase the risk of developing early-onset childhood asthma

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1. More patients in the RSV group reported asthma within 5 years compared to those in the non-RSV group.

2. Absence of a prior RSV infection decreased the 5-year risk of asthma by 26%.

Evidence Rating Level: 2 (Good)

Study Rundown: Respiratory syncytial virus (RSV) is a common childhood pathogen that may be linked to childhood asthma. To date, a definite association between RSV and asthma has not been developed and it is unclear whether prevention of the former may mitigate the latter. This prospective population-based cohort study aimed to assess the association between RSV infection in infancy and the development of childhood asthma. The primary outcome was the proportion of patients with childhood asthma at the 5-year follow-up while key secondary outcomes were recurrent wheeze and 5-year asthma inflammatory subtype. According to study results, infants with RSV infections were more prone to develop childhood asthma than those without RSV. Although this study was well done, it only looked at term infants which could limit the generalizability of findings to pre- and post-term infants who may have an altered respiratory function.

Click to read the study in The Lancet

Relevant Reading: Nirsevimab for Prevention of RSV in Healthy Late-Preterm and Term Infants

In-depth [prospective cohort]: This prospective cohort study included infants ≤ 4 months from 11 pediatric hospitals in Tennessee, USA. Infants born ≥ 37 weeks gestational age with a birthweight ≥ 2250 g and born between June to December 2012 and 2013 were included in this study. Of the 1741 patients with RSV data in infancy, the majority (n=944, 54%) had RSV infection. Furthermore, the primary outcome of 5-year current asthma was greater in the RSV-affected infant group than among those without active RSV infection (21% vs. 16%, p=0.016). Thus, lack of RSV infection decreased the 5-year risk of asthma by 26% (adjusted relative risk [aRR] 0.74, 95% confidence interval [CI] 0.58-0.94, p=0.014). Approximately 15% of 5-year current asthma cases could be prevented by avoiding RSV infection. Findings from this study suggest that the absence of RSV infection significantly decreased the risk of asthma among healthy-term infants.

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