Daily Dose: RSV LRTI in Infancy Linked to More Clinical, Pulmonary Function Sequelae

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On June 7, 2023, we reported on a study published in BMJ Open Respiratory Research that described the clinical and pulmonary function sequelae through to 2 years of age in infants who were hospitalized for respiratory syncytial virus (RSV) with lower respiratory tract infection (LRTI) and matched controls.

The study

The study was conducted at a secondary-tertiary-level hospital in Johannesburg, South Africa, from April 1, 2016, to December 31, 2019. Researchers included infants hospitalized for severe or very severe RSV LRTI (defined as “cases”) and a control group of healthy term infants not hospitalized with an LRTI in the first year of life. The control group was matched 1:1 with cases for sex and chronological age at the time of pulmonary function testing.

Investigators administered a questionnaire detailing environmental and medical history, along with a modified International Study of Asthma and Allergies questionnaire. Also, pulmonary function testing—including oscillometry, tidal breath flow-volume loops, and multiple breath wash-out—was performed at 1 and 2 years of age.

The findings

Researchers identified 964 hospitalized RSV cases (ie, infants hospitalized with RSV LRTI). There were 308 1-year-old (57% boys, median age 12.4 months) and 214 2-year-old (54% boys, median age 24.6 months) cases for study inclusion. The matched control group included 292 infants aged 1 year (53% boys; median age 12.5 months) and 209 infants aged 2 years (46% boys; median age 23.9 months).

By 1 year of age, infants in the cases group compared with the control group had increased odds of wheezing or whistling in the chest (adjusted odds ratio [aOR], 2.78, 95% CI 1.75-4.44), hospitalization for wheezing or whistling in the chest (aOR, 5.66, 95% CI 3.17-10.09), or for any LRTI (aOR, 10.43, 95% CI 4.39-24.77), and of receiving treatment for wheezing or whistling in the chest (aOR, 3.05, 95% CI, 1.70-5.47).

In addition, cases compared with controls were more likely to have reported sleep disturbance due to wheezing or whistling in the chest (aOR 8.36, 95% CI 5.42-12.90) and to have a dry cough at night (aOR 4.37, 95% CI 3.02-6.33) by age 1.

Between 1 and 2 years of age, cases remained more likely to experience wheezing or whistling in the chest (aOR 8.11, 95% CI 5.04-13.04), to be hospitalized for wheezing or whistling in the chest (aOR 58.08, 95% CI 17.98-187.59) or an LRTI (aOR 33.89, 95% CI 10.35-110.96), and to have received treatment for wheezing or whistling in the chest (aOR 21.11, 95% CI 10.76-41.45).

Clinical implications

"This study adds valuable data describing early life pulmonary sequelae after RSV LRTI. Further research is needed to better delineate the long-term effects of RSV LRTI on the developing lung as well as research describing contributory factors, such as genetic, environmental and socioeconomic, and the impact on lung function trajectories."

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