The causal direction in the association between respiratory syncytial virus hospitalization and asthma

Lone Graff Stensballe; Jacob Brunbjerg Simonsen; Simon Francis Thomsen; Anne-Marie Hellesøe Larsen; Susan Hovmand Lysdal; Peter Aaby; Kirsten Ohm Kyvik; Axel Skytthe; Vibeke Backer; Hans Bisgaard

doi:10.1016/j.jaci.2008.10.042

The causal direction in the association between respiratory syncytial virus hospitalization and asthma

Lone Graff Stensballe, Jacob Brunbjerg Simonsen, Simon Francis Thomsen, Anne-Marie Hellesøe Larsen, Susan Hovmand Lysdal, Peter Aaby, Kirsten Ohm Kyvik, Axel Skytthe, Vibeke Backer, Hans Bisgaard

92 Citations (Scopus)

Abstract

BACKGROUND: Earlier studies have reported an increased risk of asthma after respiratory syncytial virus (RSV) hospitalization. Other studies found that asthmatic disposition and propensity to wheeze increase the risk of RSV hospitalization. OBJECTIVE: The current study examined the causal direction of the associations between RSV hospitalization and asthma in a population-based cohort of twins. METHODS: We conducted a prospective cohort study examining the associations between RSV hospitalization and asthma by using registry information on RSV hospitalization and asthma among 18,614 Danish twins born 1994 to 2003. The associations between RSV and asthma were examined in both directions: we examined the risk of asthma after RSV hospitalization, and the risk of RSV hospitalization in children with asthma in the same population-based cohort. RESULTS: Asthma hospitalization after RSV hospitalization was increased as much as 6-fold to 8-fold during the first 2 months after RSV hospitalization but was no longer increased 1 year later. Asthma increased the risk of RSV hospitalization by 3-fold, and the risk was not time-dependent. Analyzing these associations on the basis of asthma defined from use of inhaled corticosteroid did not materially change the risk estimates. CONCLUSION: There is a bidirectional association between severe RSV infection and asthma. Severe RSV infection is associated with a short-term increase in the risk of subsequent asthma, suggesting that RSV induce bronchial hyperresponsiveness; and asthma is associated with a long-term increased susceptibility for severe RSV disease, suggesting a host factor being responsible for the severe response to RSV infection. This suggests that severe RSV infection and asthma may share a common genetic predisposition and/or environmental exposure.

Original language	English
Journal	Journal of Allergy and Clinical Immunology
Volume	123
Issue number	1
Pages (from-to)	131-137.e1
ISSN	0091-6749
DOIs	https://doi.org/10.1016/j.jaci.2008.10.042
Publication status	Published - 2009

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10.1016/j.jaci.2008.10.042

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@article{78b54a80689f11df928f000ea68e967b,

title = "The causal direction in the association between respiratory syncytial virus hospitalization and asthma",

abstract = "BACKGROUND: Earlier studies have reported an increased risk of asthma after respiratory syncytial virus (RSV) hospitalization. Other studies found that asthmatic disposition and propensity to wheeze increase the risk of RSV hospitalization. OBJECTIVE: The current study examined the causal direction of the associations between RSV hospitalization and asthma in a population-based cohort of twins. METHODS: We conducted a prospective cohort study examining the associations between RSV hospitalization and asthma by using registry information on RSV hospitalization and asthma among 18,614 Danish twins born 1994 to 2003. The associations between RSV and asthma were examined in both directions: we examined the risk of asthma after RSV hospitalization, and the risk of RSV hospitalization in children with asthma in the same population-based cohort. RESULTS: Asthma hospitalization after RSV hospitalization was increased as much as 6-fold to 8-fold during the first 2 months after RSV hospitalization but was no longer increased 1 year later. Asthma increased the risk of RSV hospitalization by 3-fold, and the risk was not time-dependent. Analyzing these associations on the basis of asthma defined from use of inhaled corticosteroid did not materially change the risk estimates. CONCLUSION: There is a bidirectional association between severe RSV infection and asthma. Severe RSV infection is associated with a short-term increase in the risk of subsequent asthma, suggesting that RSV induce bronchial hyperresponsiveness; and asthma is associated with a long-term increased susceptibility for severe RSV disease, suggesting a host factor being responsible for the severe response to RSV infection. This suggests that severe RSV infection and asthma may share a common genetic predisposition and/or environmental exposure.",

author = "Stensballe, {Lone Graff} and Simonsen, {Jacob Brunbjerg} and Thomsen, {Simon Francis} and Larsen, {Anne-Marie Helles{\o}e} and Lysdal, {Susan Hovmand} and Peter Aaby and Kyvik, {Kirsten Ohm} and Axel Skytthe and Vibeke Backer and Hans Bisgaard",

note = "Keywords: Asthma; Child; Child, Preschool; Denmark; Environmental Exposure; Female; Genetic Predisposition to Disease; Hospitalization; Humans; Infant; Infant, Newborn; Male; Registries; Respiratory Syncytial Virus Infections; Respiratory Syncytial Viruses; Risk Factors; Time Factors",

year = "2009",

doi = "10.1016/j.jaci.2008.10.042",

language = "English",

volume = "123",

pages = "131--137.e1",

journal = "Journal of Allergy and Clinical Immunology",

issn = "0091-6749",

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TY - JOUR

T1 - The causal direction in the association between respiratory syncytial virus hospitalization and asthma

AU - Stensballe, Lone Graff

AU - Simonsen, Jacob Brunbjerg

AU - Thomsen, Simon Francis

AU - Larsen, Anne-Marie Hellesøe

AU - Lysdal, Susan Hovmand

AU - Aaby, Peter

AU - Kyvik, Kirsten Ohm

AU - Skytthe, Axel

AU - Backer, Vibeke

AU - Bisgaard, Hans

N1 - Keywords: Asthma; Child; Child, Preschool; Denmark; Environmental Exposure; Female; Genetic Predisposition to Disease; Hospitalization; Humans; Infant; Infant, Newborn; Male; Registries; Respiratory Syncytial Virus Infections; Respiratory Syncytial Viruses; Risk Factors; Time Factors

PY - 2009

Y1 - 2009

N2 - BACKGROUND: Earlier studies have reported an increased risk of asthma after respiratory syncytial virus (RSV) hospitalization. Other studies found that asthmatic disposition and propensity to wheeze increase the risk of RSV hospitalization. OBJECTIVE: The current study examined the causal direction of the associations between RSV hospitalization and asthma in a population-based cohort of twins. METHODS: We conducted a prospective cohort study examining the associations between RSV hospitalization and asthma by using registry information on RSV hospitalization and asthma among 18,614 Danish twins born 1994 to 2003. The associations between RSV and asthma were examined in both directions: we examined the risk of asthma after RSV hospitalization, and the risk of RSV hospitalization in children with asthma in the same population-based cohort. RESULTS: Asthma hospitalization after RSV hospitalization was increased as much as 6-fold to 8-fold during the first 2 months after RSV hospitalization but was no longer increased 1 year later. Asthma increased the risk of RSV hospitalization by 3-fold, and the risk was not time-dependent. Analyzing these associations on the basis of asthma defined from use of inhaled corticosteroid did not materially change the risk estimates. CONCLUSION: There is a bidirectional association between severe RSV infection and asthma. Severe RSV infection is associated with a short-term increase in the risk of subsequent asthma, suggesting that RSV induce bronchial hyperresponsiveness; and asthma is associated with a long-term increased susceptibility for severe RSV disease, suggesting a host factor being responsible for the severe response to RSV infection. This suggests that severe RSV infection and asthma may share a common genetic predisposition and/or environmental exposure.

AB - BACKGROUND: Earlier studies have reported an increased risk of asthma after respiratory syncytial virus (RSV) hospitalization. Other studies found that asthmatic disposition and propensity to wheeze increase the risk of RSV hospitalization. OBJECTIVE: The current study examined the causal direction of the associations between RSV hospitalization and asthma in a population-based cohort of twins. METHODS: We conducted a prospective cohort study examining the associations between RSV hospitalization and asthma by using registry information on RSV hospitalization and asthma among 18,614 Danish twins born 1994 to 2003. The associations between RSV and asthma were examined in both directions: we examined the risk of asthma after RSV hospitalization, and the risk of RSV hospitalization in children with asthma in the same population-based cohort. RESULTS: Asthma hospitalization after RSV hospitalization was increased as much as 6-fold to 8-fold during the first 2 months after RSV hospitalization but was no longer increased 1 year later. Asthma increased the risk of RSV hospitalization by 3-fold, and the risk was not time-dependent. Analyzing these associations on the basis of asthma defined from use of inhaled corticosteroid did not materially change the risk estimates. CONCLUSION: There is a bidirectional association between severe RSV infection and asthma. Severe RSV infection is associated with a short-term increase in the risk of subsequent asthma, suggesting that RSV induce bronchial hyperresponsiveness; and asthma is associated with a long-term increased susceptibility for severe RSV disease, suggesting a host factor being responsible for the severe response to RSV infection. This suggests that severe RSV infection and asthma may share a common genetic predisposition and/or environmental exposure.

U2 - 10.1016/j.jaci.2008.10.042

DO - 10.1016/j.jaci.2008.10.042

M3 - Journal article

C2 - 19130934

SN - 0091-6749

VL - 123

SP - 131-137.e1

JO - Journal of Allergy and Clinical Immunology

JF - Journal of Allergy and Clinical Immunology

IS - 1

ER -

The causal direction in the association between respiratory syncytial virus hospitalization and asthma

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