Respiratory infections in early life may increase risk of future disease

A recent study published in the European Respiratory Journal shows that early respiratory tract infections can predispose individuals to chronic respiratory diseases, such as asthma, in later life. The authors1 point out that respiratory tract infections are frequent at the start of life2,3 and that beyond the short-term consequences, they can affect the development of the respiratory and immune systems.4-6 Read: Canadian screening tool could better predict asthma in children: JAMA study Methodology in brief The researchers performed a meta-analysis of individual data from 150,090 children, primarily from the European Child Cohort Network, to examine associations between upper and lower respiratory tract infections, from the age of six months to five years—and forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, forced expiratory flow rate at 75% of FVC (DEF75%) and asthma at an age median of seven years (range of 4 to 15 years). All lung function measurements were then converted to z-scores adjusted for sex, age, height and ethnicity. Principle results • The prevalence of upper and lower respiratory tract infections was highest at one year of age (average of 62.9% and 23%, respectively) and then decreased until five years of age (42.6% and 15%). • Children who suffered from a lower respiratory tract infection in early life had a higher risk of asthma at school age (OR from six months to five years between 2.10 (95% CI: 1 .98 – 2.22) and 6.30 (95% CI: 5.64 – 7.04) than those who suffered from an upper respiratory tract infection (OR between 1.25 (95% CI: 1. 18 – 1.32) and 1.55 (95% CI: 1.47 – 1.65), all p values < 0.01). • Lower respiratory tract infections at all ages except six months were associated with a 75% lower DEF (difference in z-score: -0.12 (95% CI: -0.21- 0.03) to -0.24 (95% CI: -0.39 - -0.09), p < 0.05 to 0.01). Read: SickKids study uncovers 134 genes linked to autism Talking points The results of this study are consistent with a meta-analysis of 15 studies showing that wheezing due to a rhinovirus during the first three years of life is associated with a two-fold increased risk of asthma or wheezing at an older age.7 In addition, a systematic review has shown that respiratory infections up to the age of three years are associated with a lower FEV1 at the age of 7.5 to 20 years.8 Finally, the study adds to these result by demonstrating that in the general European population, infections of the lower respiratory tract in infancy— including bronchitis, bronchiolitis, pneumonia and infection thoracic—are associated not only with lower FEV1, but also with lower FEV1/FVC and DEF75%, as well as an increased risk of asthma, which could have persistent and profound effects on function respiratory and health later in life. References 1. Van Meel, E.R. et al. (2022). Early-life respiratory tract infections and the risk of school-age lower lung function and asthma: a meta-analysis of 150,000 European children. European Respiratory Journal 60: doi.org/10.1183/13993003.02395-2021 2. Chonmaitree, T. et al. (2008). Viral upper respiratory tract infection and otitis media complication in young children. Clin Infect Dis 46, 815–823. 3. Rudan, I. et al. (2008). Epidemiology and etiology of childhood pneumonia. Bull World Health Organ 86, 408–416. 4. Openshaw, P.J. and Tregoning, J.S. (2005). Immune responses and disease enhancement during respiratory syncytial virus infection. Clin Microbiol Rev 18, 541–555. 5. Holt, P.G. (1998). Programming for responsiveness to environmental antigens that trigger allergic respiratory disease in adulthood is initiated during the perinatal period. Environ Health Perspect 106 (Suppl. 3), 795–800. 6. Daley, D. (2014). The evolution of the hygiene hypothesis: the role of early-life exposures to viruses and microbes and their relationship to asthma and allergic diseases. Curr Opin Allergy Clin Immunol 14, 390–396. 7. Liu, L. et al. (2017). Association between rhinovirus wheezing illness and the development of childhood asthma: a meta-analysis. BMJ Open 7, e013034. 8. Kouzouna, A. et al. (2016). A systematic review of early life factors which adversely affect subsequent lung function. Paediatr Respir Rev 20, 67–75. This article has been translated from its original French and originally appeared on our sister site Profession Santé. Read: If it's not asthma, what is it?

Respiratory infections in early life may increase risk of future disease

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