Rhinovirus Type in Severe Bronchiolitis and the Development of Asthma

J Allergy Clin Immunol Pract. 2020 Feb;8(2):588-595.e4. doi: 10.1016/j.jaip.2019.08.043. Epub 2019 Sep 11.


Background: Respiratory syncytial virus (RSV)- and rhinovirus (RV)-induced bronchiolitis are associated with an increased risk of asthma, but more detailed information is needed on virus types.

Objective: To study whether RSV or RV types are differentially associated with the future use of asthma control medication.

Methods: Over 2 consecutive winter seasons (2008-2010), we enrolled 408 children hospitalized for bronchiolitis at age less than 24 months into a prospective, 3-center, 4-year follow-up study in Finland. Virus detection was performed by real-time reverse transcription PCR from nasal wash samples. Four years later, we examined current use of asthma control medication.

Results: A total of 349 (86%) children completed the 4-year follow-up. At study entry, the median age was 7.5 months, and 42% had RSV, 29% RV, 2% both RSV and RV, and 27% non-RSV/-RV etiology. The children with RV-A (adjusted hazard ratio, 2.3; P = .01), RV-C (adjusted hazard ratio, 3.5; P < .001), and non-RSV/-RV (adjusted hazard ratio, 2.0; P = .004) bronchiolitis started the asthma control medication earlier than did children with RSV bronchiolitis. Four years later, 27% of patients used asthma control medication; both RV-A (adjusted odds ratio, 3.0; P = .03) and RV-C (adjusted odds ratio, 3.7; P < .001) etiology were associated with the current use of asthma medication. The highest risk was found among patients with RV-C, atopic dermatitis, and fever (adjusted odds ratio, 5.0; P = .03).

Conclusions: Severe bronchiolitis caused by RV-A and RV-C was associated with earlier initiation and prolonged use of asthma control medication. The risk was especially high when bronchiolitis was associated with RV-C, atopic dermatitis, and fever.

Keywords: Asthma development; Bronchiolitis; Respiratory syncytial virus; Rhinovirus; Wheeze; Wheezing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Asthma* / drug therapy
  • Asthma* / epidemiology
  • Asthma* / virology
  • Bronchiolitis* / drug therapy
  • Bronchiolitis* / epidemiology
  • Child
  • Child, Preschool
  • Finland / epidemiology
  • Follow-Up Studies
  • Humans
  • Infant
  • Influenza A Virus, H1N1 Subtype*
  • Male
  • Picornaviridae Infections* / complications
  • Prospective Studies
  • Respiratory Sounds
  • Rhinovirus* / classification
  • Rhinovirus* / pathogenicity