Wheezing on admission: a marker for bronchiolitis severity and asthma development

Abstract

Background: Supervised clustering of bronchiolitis patients, according to their clinical characteristics at hospital admission, helps predict short-term hospital outcomes and the risk of developing childhood respiratory illness. Thus, we evaluated the use of wheezing status for stratifying bronchiolitis patients.

Methods: A prospective cohort study was conducted involving 668 previously healthy, full-term Chilean infants ( < 2 years old) hospitalized with bronchiolitis. Patients categorized based on their wheezing status at hospital admission were monitored during hospitalization and followed for 4 years after discharge.

Results: Wheezing children presented a more severe illness requiring more oxygen during their hospital stay. Upon discharge, they were more likely to develop preschool wheezing at 12 months and asthma at 4 years of age. Among the non-wheezing, those with RSV had more severe disease. Risk factors exclusively associated with persistent asthma development for the wheezing were clinical bacterial coinfection, parental asthma history, and having had a severe bronchiolitis episode. Risk factors exclusive for non-wheezing were maternal smoking during pregnancy and severe retractions.

Conclusion: Bronchiolitis patients can be categorized based on their wheezing status at hospital admission, helping predict short-term clinical outcomes and identify infants at risk of developing severe short- and long-term respiratory illnesses.

Impact: Stratifying viral bronchiolitis patients using a simple bedside strategy based on their wheezing status at hospitalization can help improve individual-based clinical decisions during hospitalization and enable early identification of infants with a higher risk of developing severe respiratory illnesses and long-term associated diseases. Viral bronchiolitis patients can be stratified based on their hospitalized wheezing status. Wheezing patients exhibited similar clinical patterns during hospitalization and long-term clinical outcomes upon discharge. Wheezing infants were more likely to develop preschool wheezing and asthma.