Background: The role of respiratory syncytial virus (RSV) in the development of asthma/wheezing (AW) has been evaluated in several studies, mostly among pre-term infants or among infants after developing severe RSV-related disease. We describe the cumulative incidence (CI) of AW among hospitalized/ambulatory neonates/infants/toddlers after RSV/bronchiolitis infection diagnosis, in a large clinical database.
Methods: Using deidentified Optum Integrated commercial claims and electronic medical records, we identified patients (0-<3 years old) with a first clinical diagnosis of RSV/bronchiolitis infection from 01January2008 – 31March2016. Patients with a diagnosis of asthma/wheezing ≤30 days after first RSV/bronchiolitis diagnosis were excluded. Three cohorts were created with 1/3/5 years of follow-up time required, respectively. Patients were grouped by specific high-risk factors (HRF+/-), including pre-term births and predefined pre-existing disease. Descriptive statistics are reported, with comparisons made by logistic regression analyses.
Results: 9,811/4,524/1,788 patients with RSV/bronchiolitis infection and HRF- were included in the 1/3/5-years follow-up cohorts. 14.9%/28.2%/36.3% had AW events by the end of follow-up in the 3 cohorts. 6.5%/6.9%/5.8% were hospitalized for RSV/bronchiolitis.
3,030/1,378/552 patients with RSV/bronchiolitis infection and HRF+ were included in the 1/3/5-years follow-up cohorts. 18.1%/32.9%/37.9% had AW events by the end of follow-up in the 3 cohorts. 11.4%/11.1%/11.6% were hospitalized for RSV/bronchiolitis.
The CI rates of AW in the 1/3/5-year HRF+/- cohorts, stratified by hospitalized for RSV/bronchiolitis Y/N, are shown in Figure 1.
Logistic regression confirmed that hospitalization for RSV/bronchiolitis was associated with an increased (p<0.05) likelihood of AW, for HRF+ and HRF- patients at each follow-up year.
Conclusion: 38% of RSV/bronchiolitis infants/neonates/toddlers HRF+, and 36% among infants/neonates/toddlers HRF-, developed AW in the five years after first RSV/bronchiolitis diagnosis. RSV/bronchiolitis hospitalization was associated with a significantly increased risk of AW development in 1/3/5 years of follow-up; confirming previous observational study results.
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