Increased on Childhood Recurrent Wheezing and Asthma after Respiratory Syncytial Viral (RSV) Infection in Full Term Infants

Background: Studies suggest that RSV infection early in life is associated with the development of recurrent wheezing, yet, information on large population-based studies among US full-term healthy infants is incomplete. The objective of this study was to evaluate the risk of developing post-RSV recurrent wheezing/asthma during childhood among full-term infants in a US commercially-insured population.

Methods: Retrospective, observational study used data from Truven MarketScan Commercial Claims and Encounters Database (1/1/2000 - 12/31/2016) to identify full-term infants with and without a RSV diagnosis in the 1st year of life (RSV and non-RSV cohorts respectively). Infants were excluded if they had any of the following: prematurity (< 37 weeks’ gestation), low birth weight, small for gestational age, congenital heart or chronic lung disease, asthma or wheezing; or had received palivizumab. At least 2 years’ continuous follow-up post birth was required throughout the ≤5-year follow up period. RSV/non-RSV infants were 1:1 matched for gender, region and health plan type. Cumulative incidence of recurrent wheezing or asthma was identified by ICD-9/10 codes, through 1, 2, 3 and 4 years (Y)’ post-index (1 year after birth) follow up, and analyzed using conditional logistic regression.

Results: Matched RSV/ non-RSV pairs totaled 38,494 (Y1), 25,603 (Y2), 17,429 (Y3), and 11,921 (Y4) for the years’ follow up. Demographic characteristics, birth year and month were evenly represented between cohorts. Other infections during the perinatal period were more common in the RSV vs. the non-RSV cohort (5.4% vs. 3.2%; p<0.0001), as were other respiratory conditions (5.8% vs. 2.6%; p<0.0001), and antibiotic use (76.7% vs. 44.7%; p<0.0001). Rates of influenza and pneumococcal vaccinations were comparable between cohorts. Cumulative incidence of recurrent wheezing or asthma in the RSV cohort was more than two-fold higher compared with the non-RSV cohort for each follow up period (p<0.001) [Figure 1].

Conclusion: Healthy, full-term, commercially-insured children infected with RSV during the first year of life had from 2.2 to 3.6-fold increased risk of developing recurrent wheezing or asthma in the next 1-4 years.  This reveals an important medical need for interventions targeting RSV infection in infants. 

Figure 1

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