Wheeze and Diarrhea in the Course of a Viral Respiratory Inception During the Fisrt Two Years of Life are Predictors of Development of Asthma at Ages 6 and 8

RATIONALE: The aim of the study was to determine whether clinical characteristic during moderate to severe viral illness (MSI) in infancy are related to the subsequent development of asthma. METHODS: Clinical characteristics of MSI in the first two years and their relationship with the diagnosis of asthma at 6 and 8 years of age were analyzed in 236 children from the COAST cohort. RESULTS: In univariate analyses, clinical surrogates of severity of viral illness were associated with the diagnosis of asthma at age 6 and 8. The association was stronger for the presence of wheeze fever and diarrhea during MSI before 2 years of age. However, in multivariate analysis, only wheeze and diarrhea are independent and synergic risk factors for the diagnosis of asthma at 6 and 8 years of age. As for diagnosis of asthma at age 8, adjusted OR (± 95% CI) for wheeze and diarrhea during a viral MSI in the first two years of life were 2.6 (1.4 - 4.8) [p = 0.002] and 1.9 (0.99 - 3.5) [p = 0.05] respectively. Similar values were obtained at age 6. CONCLUSIONS: As expected, wheeze in the course of a viral MSI in early age constitutes a risk factor for the subsequent development of asthma. More striking is that diarrhea provides additive information. In addition to random chance for these associations, other possible explanations would be: global impairment of the host immune response, underlying abnormalities in gut flora, or viral co-infections of the respiratory and GI tract that induce more severe disease.