Follow up of Ventilatory Function in Infant After Bronchiolitis During the First Year of Life
Condition: Bronchiolitis
MeSH terms: Bronchiolitis
Study type: Interventional

Summary: 
      A significant proportion of asthma is diagnosed during childhood. Bronchiolitis is the most
      common lower respiratory tract illness (LRI) in early life and the present work is a
      prospective study undertaken to highlight the possible relationship between LRI in early life
      and trigger of atopy and asthma in 3 year-old childhood, using paediatric lung function
      testing.

      Twenty nine infants (8 females and 21 males) were included in our study. The beginning of the
      study started at least three weeks after the first bronchiolitis episode. Pulmonary function
      test was realized using an infant specific body plethysmography (Babybody, Erich Jaeger,
      Germany). Same tests were performed at 18 and 24 months. At 30 and 36 months, pulmonary
      function was evaluated by measuring respiratory resistances using oscillometry and occlusion
      systems (Masterlab-IOS, Erich Jaeger, Germany). If measured data showed an obstruction, a
      bronchodilatator was inhaled to assess reversibility. When results were normal, a bronchial
      provocation test, using inhaled metacholine, was performed.

      Skin prick tests (SPTs) were performed during the first exam, and at 24 and 36 months
      (Stallergenes-DHS).

      Collection of data was largely incomplete due to a number of patients lost of follow up.
      Based on the available data, it can be conclude that most of lung tests results were in the
      normal range but a non negligible bronchial hyper reactivity was documented (41% of
      patients).

      This study must be continued to increase the number of included patients and to continue
      their follow up during a longer time.
    

Detailed description: 
      Asthma affects a large population throughout the world and about two millions of persons in
      France, killing two hundred patients by year. A significant proportion of cases of asthma are
      diagnosed during childhood. Understanding the relation between early-life infectious
      exposures and asthma and atopy appears to be considerable interest.

      Respiratory infectious illnesses, mostly viral, are very common in childhood. Bronchiolitis
      is the most common lower respiratory tract illness (LRI) in early life (1). It is commonly
      caused by respiratory syncytial virus (RSV) and is often associated with subsequent wheezing
      and childhood asthma (2). Respiratory infectious illnesses caused by other agent than RSV can
      be also associated with asthma and atopy (3). However, the relation between respiratory
      infectious illnesses in early life and asthma in childhood is again much debated since some
      studies show a relationship between bronchiolitis and atopy (4) but not others (5, 6).

      The present work is a prospective study undertaken to highlight the possible relationship
      between LRI in early life and trigger of atopy and asthma in 3 year-old childhood, using
      paediatric lung function testing.

      Twenty nine infants (8 females and 21 males) were included in our study and 8 of 29 infants
      were of premature birth. The youngest patient was 3 months old and the older fourteen months
      old. The beginning of the study started at least three weeks after the first bronchiolitis
      episode. Pulmonary function test was realized using body plethysmography (Babybody, Erich
      Jaeger, Germany). Same tests were performed at 18 and 24 months. At 30 and 36 months,
      pulmonary function was evaluated by measuring respiratory resistances using an oscillometry
      system and an occlusion system (Masterlab-IOS, Erich Jaeger, Germany). All respiratory tests
      were performed on patients in asymptomatic respiratory condition and at least one month apart
      from respiratory infection. If measured data showed an obstruction, a bronchodilator was
      inhaled to assess reversibility. When results were normal, a bronchial provocation test,
      using inhaled metacholine, was performed.

      Skin prick tests (SPTs) were performed at the first exam, and at 24 and 36 months
      (Stallergenes-DHS). Dermatophagoides pteronyssinus, alternaria, cat dander, cockroach,
      orchard grass and timothy grass were systematically tested. The SPTs were considered positive
      when the wheal diameter was over 3 mm and 50% larger than the positive control, and the
      negative control remained negative (7). The possibility of dermographism was eliminated by a
      negative reaction of the negative control.

      Collection of data was largely incomplete due to a number of patients lost of follow up.
      Briefly, based on the available data, most of lung tests results were in the normal range
      although a proportion of patients experienced recurrent wheezing episodes during follow up.
      Nevertheless a bronchial hyper reactivity to metacholine was documented in 41%. Atopy, as
      screened by SPTs, was detected in a minority of infants (13.5%). Coexistence of bronchial
      hyper reactivity and atopy was present in only one patient.

      These incomplete results highlight the complex interplay between symptoms, bronchial
      obstruction, bronchial hyper reactivity and atopy in the subsequent development of asthma in
      wheezy children. Long term follow up is necessary to assess the prognostic value of these
      parameters.
    

Intervention name(s): body plethysmography
Intervention type(s): Procedure
Intervention description(s): Same tests were performed at 18 and 24 months. At 30 and 36 months, pulmonary function was evaluated by measuring respiratory resistances using an oscillometry system and an occlusion system
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic