Asthma after bronchiolitis: Five years of follow-up

Background It is well known that bronchiolitis is associated to wheezing and asthma. Aim To evaluate the presence and the risk for atopy and asthma in children 5 years after bronchiolitis. Methods From October 2004 to May 2010, we studied 158 children (81 M, median age 5.6) hospitalized for bronchiolitis at the Paediatric Emergency Department “Sapienza” University of Rome. Demographic and clinical datawere obtained from each infant together withnasopharyngeal washing for the detection of 14 respiratory viruses at admission in the hospital. Every 12 months after discharge, one of the authors interviewed parents of all infants using a standardized telephone procedure with structured questionnaire seeking information on wheezing. At 5 years, each child underwent skin prick test. Results At 5 years follow-up, 43(27.2%) children had positive prick tests: 13(30%) have asthma, 19(44%) had pre-school wheezing and 11(26%) have no clinical symptoms. Family history of asthma and >400 blood eosinophils/mm3(>400 E) during bronchiolitis were more frequent in atopic vs non atopic children (32.6%vs17.5%, p=0.035; 16.3%vs3.5%, p=0.01, respectively). Bronchiolitis from RV was more frequent in children who have developed atopy comparing to non-atopic children(14%vs7.8%,p=ns). Among atopic children, children with asthma had more frequently >400 E and bronchiolitis from RV comparing to children who had preschool wheezing and without symptoms(38.5%vs10.5%vs0,p=0.026; 23.1%vs10.5%vs9.1%, p:ns). Conclusions In children with bronchiolitis, blood eosinophils >400/mm 3 and RV infections may predict the occurrence of atopic asthma after 5 years of follow up.