The Journal of Allergy and Clinical Immunology
Volume 123, Issue 1 , Pages 131-137.e1, January 2009

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

  • Lone Graff Stensballe, MD, PhD

      Affiliations

    • Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
    • Danish Pediatric Asthma Center, University Hospital of Gentofte, Copenhagen, Denmark
    • Corresponding Author InformationReprint requests: Lone Graff Stensballe, MD, PhD, Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
    • ,
  • Jacob Brunbjerg Simonsen, MSc

      Affiliations

    • Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
    • ,
  • Simon Francis Thomsen, MD, PhD

      Affiliations

    • Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
    • ,
  • Anne-Marie Hellesøe Larsen, MSc

      Affiliations

    • Danish Pediatric Asthma Center, University Hospital of Gentofte, Copenhagen, Denmark
    • ,
  • Susan Hovmand Lysdal, MSc

      Affiliations

    • Danish Pediatric Asthma Center, University Hospital of Gentofte, Copenhagen, Denmark
    • ,
  • Peter Aaby, DMSci

      Affiliations

    • Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
    • ,
  • Kirsten Ohm Kyvik, MD, PhD

      Affiliations

    • Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
    • Danish Twin Registry, Epidemiology, Institute of Public Health, University of Southern Denmark, Odense, Denmark
    • ,
  • Axel Skytthe, MSc, PhD

      Affiliations

    • Danish Twin Registry, Epidemiology, Institute of Public Health, University of Southern Denmark, Odense, Denmark
    • ,
  • Vibeke Backer, MD, DMSci

      Affiliations

    • Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
    • ,
  • Hans Bisgaard, MD, DMSci

      Affiliations

    • Danish Pediatric Asthma Center, University Hospital of Gentofte, Copenhagen, Denmark

Received 6 July 2008; received in revised form 11 October 2008; accepted 14 October 2008.

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.

Key words: Asthma, child, epidemiology, respiratory syncytial virus, twins

Abbreviations used: CRS, Danish Civil Registration System, DNPR, Danish National Patient Registry, RMPS, Register of Medicinal Product Statistics, RSV, Respiratory syncytial virus

 

 Supported by the Lundbeck Foundation, the Augustinus Foundation, and an unrestricted institutional grant from MedImmune.

 Disclosure of potential conflict of interest: V. Backer receives grant support from AstraZeneca, Boehringer Ingelheim, ALK-Abelló, and Novartis. H. Bisgaard has been a consultant to, has been a paid lecturer for, and holds sponsored grants from Aerocrine, AstraZeneca, Altana, GlaxoSmithKline, Merck, MedImmune, NeoLab, and Pfizer; receives grant support from Aerocrine, AstraZeneca, GlaxoSmithKline, Merck, and MedImmune; and has provided legal consultation/expert witness testimony for NeoLab. The rest of the authors have declared that they have no conflict of interest.

PII: S0091-6749(08)01918-0

doi:10.1016/j.jaci.2008.10.042

The Journal of Allergy and Clinical Immunology
Volume 123, Issue 1 , Pages 131-137.e1, January 2009

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