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Outcome for acute bronchitis, bronchiolitis, and pneumonia in infancy.

Outcome for acute bronchitis, bronchiolitis, and pneumonia in infancy. Arch Dis Child: first published as 10.1136/adc.59.4.306 on 1 April 1984. Downloaded from http://adc.bmj.com/ on July 13, 2021 by guest. Protected by copyright. Archives of Disease in Childhood, 1984, 59, 306-309 for acute bronchitis, bronchiolitis, and Outcome pneumonia in infancy H SIMPSON J Y Q MOK AND The Royal Hospital for Sick Children, Edinburgh and the Department of Child Health, University of Leicester SUMMARY The clinical and respiratory function characteristics of 200 children 7 years after their tract infection in infancy have been presented.1 admission to hospital with acute lower respiratory analysed according to disease category (bronchitis, bronchiolitis, or Results were subsequently diagnostic category recurrent cough and wheeze, pneumonia) at initial presentation. Within each a for colds 'to go to the chest', medication, absence from school, and family doctor tendency significantly increased. Ventilatory function was diminished and bronchial consultations were reactivity increased when compared with matched controls. Studies of a different design are required to elucidate the mechanisms whereby symptoms are increased, ventilatory function impaired, and bronchial reactivity increased after severe lower respiratory infection in infancy. We have previously reported preliminary findings of The 200 index children were selected at Subjects. a case follow up study of 200 children group of infants admitted to control, random from a larger with acute lower tract infection admitted to hospital with acute lower respiratory hospital respiratory When reviewed after 7 in infancy. In 100 children, respiratory syncytial tract infection in infancy.' of virus infection was proved; in the remaining 100, years, index children had an increased prevalence infection was not confirmed by culture or immuno- cough, wheeze, and established asthma; ventilatory and bronchial reactivity fluorescent investigation of nasopharyngeal secre- function was impaired from the same matched controls. The tions. Each control child was chosen increased compared with index and of index and control children class in the same school as the child, atopic backgrounds where possible, height. were similar but the former were at a considerable matched for sex, age and, and None of the control children had had a respiratory disadvantage with regard to social family illness in infancy necessitating admission to hospital. characteristics. factors that We have examined additional may influenced and report here the Methods. Index children had carefully documented have outcome, and clinical including chest radiographs, effects of index diagnosis (bronchitis, bronchiolitis, records, to the criteria on status. diagnoses were coded according and pneumonia) subsequent respiratory as to a multicentre Our accompanying paper2 discusses the occurrence suggested by Court3 a prelude and wheeze that was All records of recurrent or persistent cough study subsequently published.4 to ensure that and the were reviewed by one person (JM) (irrespective of clinical diagnosis) possible adhered to. several influence of status and bronchial reactivity on Court's criteria had been Thus, atopic of 'bronchiolitis' were reclassified as 'pneu- prognosis. cases monia', before inclusion in the study, largely on the and methods basis of chest radiological findings. Subjects control children attended with their Index and criteria for for review about 7 years later. A detailed Details of index children and controls, parents of the under- questionnaire on clinical, social, and family aspects their selection, the plan investigation was of our methods were of health since the index illness completed, taken, and a description given and tests of in A brief summary is given followed by clinical examination respira- the preliminary report.' General records were here. tory function. practitioner 306 Arch Dis Child: first published as 10.1136/adc.59.4.306 on 1 April 1984. Downloaded from http://adc.bmj.com/ on July 13, 2021 by guest. Protected by copyright. Outcome for acute bronchitis, bronchiolitis, and pneumonia in infancy 307 scrutinised in over two thirds of cases, the same bronchitis as including all criteria, four or more index and control children reporting subsequent of episodes cough. cough or wheeze. were more Respiratory symptoms common in index subgroups than in their case respective control Statistical analysis or wheeze was in the or groups. Cough greatest year two after index and decreased illnesses, gradually For matched pairs, continuous data were analysed thereafter. An increase in asthma and bronchitis was using Student's t test and the Wilcoxon test for observed at the of age 7 years in each subgroup, but non-parametric data. Analysis of categorical or did not reach statistical significance in any. For each qualitative data was performed using McNemar's diagnostic subgroup, index children lost more test.5 consulted their schooling, general practitioners more and received more often, medication (mainly Results antibiotics) than their respective case controls. Children with bronchitis did not differ from Diagnostic category. The index illness was bronchitis controls with respect to social in class, position in 45 children, bronchiolitis in 104, and pneu- number of family, siblings, parental smoking habits, monia in 51. The boy:girl ratio was almost 2:1 for or of at follow age parents up. More children with bronchitis and bronchiolitis and 1:1 for pneumonia. bronchiolitis and pneumonia came from social clas- Within each subgroup, index children were younger ses IV and V values and (P <0-05), fewer children by 0-2 years on average (P<0001), and smaller by with those conditions were first born (respective P approximately 2 cm (P<0-001-P<0-02) than corres- values <0-01 and <0-05). The number of siblings of ponding control children. Children who had had children who had had pneumonia was significantly pneumonia were lighter at birth than their controls increased (P<0001). (mean (SD), index 3-1 (0-7) kg, controls 3.3 (0 4) When atopic backgrounds were assessed, no kg; P<0.03) and fewer index than control children differences were seen between index and control in the bronchiolitis subgroup were breast fed (index children in the personal histories of eczema, hay- 8-7%, controls 21-2%; P<0.02). or food nor fever, allergy, did differences exist Table 1 gives details of subsequent outcome. between the three subgroups. The family histories 'Established' respiratory disorders were diagnosed were also similar, with the exception that asthma on the basis of clinical findings at follow up, scrutiny was reported more frequently among first degree of general practitioner records, and, where applic- relatives of children with bronchitis (index 60%, able, hospital case records. Thus, asthma was control 28.9%, P<0-001). defined as four or more episodes of wheeze requir- Table 2 gives the results of respiratory function ing medical attention in the preceding year, and by tests, each expressed as a percentage of the pre- Table 1 Respiratory status at 7 years in relation to of age, initial clinical diagnosis Bronchitis Bronchiolitis Pneumonia (n = 45) (n = = 104) (n 51) Index Control Index Control Index Control Cough (%) At any time 42 2 11 1 29.X8 14-4 37-3' 11-8 In past year 0 15-6 7-7 21 6 15-4 5-9 Colds 'going to chest' (%) 60-t 8 17 519 19-2 47-1 25-5 Tendency to wheeze (%) At time any 60 0 8X9 44-2* 18X3 41-2t 21-6 In past year 6-7 2-2 10-6 () 13-7 2-( Medication in past (%) year 42-2 156 462 15-4 47-1* 23-5 Antibiotics 37.8 13 3 423 14-4 43-1 19-6 Bronchodilators 11 1 4-4 10.6 4-8 118 3X9 Weeks off school for respiratory illness in past vear (mean (SD))4 1 4 (2-2) 0(7 (1-0) 18- (2 6) 0-8 (1-5) 2-4 (6-0) ()18 (1-1) No of general practitioner consultations for respiratory illness in past year (mean (SD))' 1-9 (2-5)t 0.9 (18) 1-6 0-8 (2-5) (1-3) 3-1 (8-6) 1-3 (2-)) Established asthma (%) 13-3 2-2 6-7 10( 7-8 5-9 Established bronchitis 0 0 (%) 4-8 0 3-9 P<0-01; tP<0l)5; tP<0l(X)(. Statistical McNemar's test. analysis, test; 4Wilcoxon Arch Dis Child: first published as 10.1136/adc.59.4.306 on 1 April 1984. Downloaded from http://adc.bmj.com/ on July 13, 2021 by guest. Protected by copyright. 308 Mok and Simpson Table 2 Respiratory function tests in relation to initial diagnosis Bronchiolitis Pneumonia Bronchitis (n = 44) In = 102) (n = 51) Index Control Index Control Inidex Control FEV in 0(75 sec (% predicted) 89f2 91-2 87.0 92 6 91 5 94.6 FEV in 1-0 sec (% 90(4 94-5 90.7t 94 8 93 3 95'7 predicted) FVC (% predicted) 83.7 86.6 86-2 86-4 88-7 88X6 (% predicted) 96 1 99.1 89-1 101 3 93 4f 107 2 FEF2575 FEV:FVC (09(0 (91 0(88 (091 0-89 (091 20(0 32-7 25-0 35-3 21 6 Fall in PEFR of 10% after exercise (%), 37-8 = = forced vital capacity; FEF2s7s = forced mid-expiratory flow (between 25% and 75% of FVC); PEFR = peak expiratory FEV forced expiratory volume; FVC flow rate. tP<0-05. Statistical analysis, Student's paired t !McNemar's test. .P<0-01; test; or Children with suffered. Thus sequelae after bronchitis pneu- dicted normal value for height. are less well documented than for bronchioli- reduction in forced monia bronchiolitis had a significant were increased in our in one and in three quarters tis. Respiratory symptoms expiratory volume index children, irrespective of the initial clinical flow of a second, forced mid-expiratory (between Although ventilatory function was un- and of forced vital capacity), and in forced diagnosis. 25% 75% equivocally reduced in children who suffered from volume in one second:forced vital expiratory bronchiolitis, a diminution in respiratory function capacity. Ventilatory function was also lower in was also observed in children who had had bronchi- bronchitis and pneumonia index children, but this statistical Bronchial tis or pneumonia. Failure to achieve did not reach statistical significance. the each index subgroup, significance may have been caused by relatively reactivity was increased in smaller number studied with the latter index but not As the numerical differences significantly. conditions. between index subgroups might have affected the It may be argued that separation of children on results obtained, an analysis of variance was diagnostic criteria based purely on clinical and performed between index children and controls radiological assessments is artifical, in view of the for each respiratory function variable measured. between the sub- observed within a considerable aetiological overlap This showed that the differences in differences between groups defined. There are also difficulties disting- disease category exceeded the with bronchiolitis from conclude uishing the infant presenting disease categories. We cannot, therefore, his first asthmatic attack, as viral that specific risk with regard to one suffering bronchiolitis confers are well known to precipitate ventilatory function, in view of the relatively smaller respiratory infections attacks of asthma.' 1 In assigning index children to a number of children studied with a history of diagnostic grouping Court's recommendations were bronchitis or pneumonia. followed strictly. Moreover, the pneumonia group Discussion by infants with proved bacterial was not weighted fewer than 14% infections-in each subgroup These results suggest that the outcome of acute of infants studied had bacterial isolates from lower respiratory tract infections in infancy is throat and nasal blood culture, or bacteriolo- swabs, illness suffered. unaffected by the type of index studies of tracheal aspirates, on the few gical mainly on the obtained. On the Previous workers have concentrated occasions when the latter were sequelae after acute bronchiolitis;68 others have findings it seems reasonable to basis of these attempted to differentiate acute infectious bron- that serious infections of the lower respira- postulate bronchiolitis that may repre- of chiolitis from sporadic tract during a 'vulnerable' period lung tory sent a first asthmatic attack.i't We had shown no have growth (whatever the clinical diagnosis) may differences in clinical characteristics and outcome contributed or indirectly to the subsequent directly of between children with proved respiratory syncytial increase in symptoms and impairment lung virus infection and those without,' but recognise function. that this virus could have been responsible for the We that the outcome for conclude, therefore, lack of illness in the latter group despite the acute lower respiratory tract infection severe to in the virological confirmation. enough to necessitate admission hospital To our there has been no previous is not the knowledge first year of life affected appreciably by relating outcome to the type of index illness of index illness suffered. A larger series is study type Arch Dis Child: first published as 10.1136/adc.59.4.306 on 1 April 1984. Downloaded from http://adc.bmj.com/ on July 13, 2021 by guest. Protected by copyright. Outcome for acute bronchitis, bronchiolitis, and pneumonia in infancy 309 necessary to settle whether bronchiolitis is more McNemar 0. Note on sampling error of the differences between correlated proportions or percentages. Psychometrika likely than bronchitis or pneumonia to be associated 1947;12:153-7. with abnormalities of ventilatory function in later Rooney JC, Williams HE. The relationship between proved childhood. viral bronchiolitis and subsequent wheezing. J Pediatr ;79:774-7. This study was supported by a generous grant from the Chest, 7 Sims DG, Downham MAPS, Gardner PS, et al. Study of 8 Heart, and Stroke Association. We thank Dr J M Inglis, Dr M year-old children with a of virus history respiratory syncytial Fulton, Miss C Jagger, and Mrs P Walker. We also thank general bronchiolitis in infancy. Br Med J 1978;i:11-4. practitioners for their cooperation, and all the children and parents 8 Pullan CR, Hey EN. Wheezing, asthma, and pulmonary who participated in the study. dysfunction 10 years after infection with respiratory syncytial virus in infancy. Br Med J 1982;284:1665-9. Simon G, Jordan WS. Infectious and of allergic aspects References bronchiolitis. J Pediatr 1967;70:533-8. 1 Mok JYQ, Simpson H. Outcome of acute lower respiratory 10 Polmar SH, Robinson LD, Minnefor AB. Immunoglobulin E in tract infection in infants: preliminary report of seven year bronchiolitis. Pediatrics 1972;50:279-84. follow-up study. Br Med J 1982;285:333-7. Berkovitch S, Millian SJ, Snyder RD. The association of viral 2 Mok JYQ, Simpson H. Symptoms, atopy, and bronchial and mycoplasma in in infections the recurrence of wheezing the reactivity after lower respiratory infection in infancy. Arch asthmatic child. Ann Allergy 1970;28:43-9. Dis Child 1984;59:299-305. Court SDM. The definition of acute respiratory illnesses in children. Postgrad Med J 1973;49:771-6. Correspondence to Professor H Simpson, University of Leicester, Clarke SKR, Gardner PS, Poole PM, et al. Respiratory syncytial Department of Child Health, Clinical Sciences Building, Leicester virus infection: admissions to hospital in industrial, urban and Royal Infirmary, Leicester LE2 7LX. rural areas. Report to the Medical Research Council subcom- mittee on respiratory syncytial virus vaccines. Br Med J Received 28 1978;ii:796-8. December 1983 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Disease in Childhood Unpaywall

Outcome for acute bronchitis, bronchiolitis, and pneumonia in infancy.

Archives of Disease in ChildhoodApr 1, 1984

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Abstract

Arch Dis Child: first published as 10.1136/adc.59.4.306 on 1 April 1984. Downloaded from http://adc.bmj.com/ on July 13, 2021 by guest. Protected by copyright. Archives of Disease in Childhood, 1984, 59, 306-309 for acute bronchitis, bronchiolitis, and Outcome pneumonia in infancy H SIMPSON J Y Q MOK AND The Royal Hospital for Sick Children, Edinburgh and the Department of Child Health, University of Leicester SUMMARY The clinical and respiratory function characteristics of 200 children 7 years after their tract infection in infancy have been presented.1 admission to hospital with acute lower respiratory analysed according to disease category (bronchitis, bronchiolitis, or Results were subsequently diagnostic category recurrent cough and wheeze, pneumonia) at initial presentation. Within each a for colds 'to go to the chest', medication, absence from school, and family doctor tendency significantly increased. Ventilatory function was diminished and bronchial consultations were reactivity increased when compared with matched controls. Studies of a different design are required to elucidate the mechanisms whereby symptoms are increased, ventilatory function impaired, and bronchial reactivity increased after severe lower respiratory infection in infancy. We have previously reported preliminary findings of The 200 index children were selected at Subjects. a case follow up study of 200 children group of infants admitted to control, random from a larger with acute lower tract infection admitted to hospital with acute lower respiratory hospital respiratory When reviewed after 7 in infancy. In 100 children, respiratory syncytial tract infection in infancy.' of virus infection was proved; in the remaining 100, years, index children had an increased prevalence infection was not confirmed by culture or immuno- cough, wheeze, and established asthma; ventilatory and bronchial reactivity fluorescent investigation of nasopharyngeal secre- function was impaired from the same matched controls. The tions. Each control child was chosen increased compared with index and of index and control children class in the same school as the child, atopic backgrounds where possible, height. were similar but the former were at a considerable matched for sex, age and, and None of the control children had had a respiratory disadvantage with regard to social family illness in infancy necessitating admission to hospital. characteristics. factors that We have examined additional may influenced and report here the Methods. Index children had carefully documented have outcome, and clinical including chest radiographs, effects of index diagnosis (bronchitis, bronchiolitis, records, to the criteria on status. diagnoses were coded according and pneumonia) subsequent respiratory as to a multicentre Our accompanying paper2 discusses the occurrence suggested by Court3 a prelude and wheeze that was All records of recurrent or persistent cough study subsequently published.4 to ensure that and the were reviewed by one person (JM) (irrespective of clinical diagnosis) possible adhered to. several influence of status and bronchial reactivity on Court's criteria had been Thus, atopic of 'bronchiolitis' were reclassified as 'pneu- prognosis. cases monia', before inclusion in the study, largely on the and methods basis of chest radiological findings. Subjects control children attended with their Index and criteria for for review about 7 years later. A detailed Details of index children and controls, parents of the under- questionnaire on clinical, social, and family aspects their selection, the plan investigation was of our methods were of health since the index illness completed, taken, and a description given and tests of in A brief summary is given followed by clinical examination respira- the preliminary report.' General records were here. tory function. practitioner 306 Arch Dis Child: first published as 10.1136/adc.59.4.306 on 1 April 1984. Downloaded from http://adc.bmj.com/ on July 13, 2021 by guest. Protected by copyright. Outcome for acute bronchitis, bronchiolitis, and pneumonia in infancy 307 scrutinised in over two thirds of cases, the same bronchitis as including all criteria, four or more index and control children reporting subsequent of episodes cough. cough or wheeze. were more Respiratory symptoms common in index subgroups than in their case respective control Statistical analysis or wheeze was in the or groups. Cough greatest year two after index and decreased illnesses, gradually For matched pairs, continuous data were analysed thereafter. An increase in asthma and bronchitis was using Student's t test and the Wilcoxon test for observed at the of age 7 years in each subgroup, but non-parametric data. Analysis of categorical or did not reach statistical significance in any. For each qualitative data was performed using McNemar's diagnostic subgroup, index children lost more test.5 consulted their schooling, general practitioners more and received more often, medication (mainly Results antibiotics) than their respective case controls. Children with bronchitis did not differ from Diagnostic category. The index illness was bronchitis controls with respect to social in class, position in 45 children, bronchiolitis in 104, and pneu- number of family, siblings, parental smoking habits, monia in 51. The boy:girl ratio was almost 2:1 for or of at follow age parents up. More children with bronchitis and bronchiolitis and 1:1 for pneumonia. bronchiolitis and pneumonia came from social clas- Within each subgroup, index children were younger ses IV and V values and (P <0-05), fewer children by 0-2 years on average (P<0001), and smaller by with those conditions were first born (respective P approximately 2 cm (P<0-001-P<0-02) than corres- values <0-01 and <0-05). The number of siblings of ponding control children. Children who had had children who had had pneumonia was significantly pneumonia were lighter at birth than their controls increased (P<0001). (mean (SD), index 3-1 (0-7) kg, controls 3.3 (0 4) When atopic backgrounds were assessed, no kg; P<0.03) and fewer index than control children differences were seen between index and control in the bronchiolitis subgroup were breast fed (index children in the personal histories of eczema, hay- 8-7%, controls 21-2%; P<0.02). or food nor fever, allergy, did differences exist Table 1 gives details of subsequent outcome. between the three subgroups. The family histories 'Established' respiratory disorders were diagnosed were also similar, with the exception that asthma on the basis of clinical findings at follow up, scrutiny was reported more frequently among first degree of general practitioner records, and, where applic- relatives of children with bronchitis (index 60%, able, hospital case records. Thus, asthma was control 28.9%, P<0-001). defined as four or more episodes of wheeze requir- Table 2 gives the results of respiratory function ing medical attention in the preceding year, and by tests, each expressed as a percentage of the pre- Table 1 Respiratory status at 7 years in relation to of age, initial clinical diagnosis Bronchitis Bronchiolitis Pneumonia (n = 45) (n = = 104) (n 51) Index Control Index Control Index Control Cough (%) At any time 42 2 11 1 29.X8 14-4 37-3' 11-8 In past year 0 15-6 7-7 21 6 15-4 5-9 Colds 'going to chest' (%) 60-t 8 17 519 19-2 47-1 25-5 Tendency to wheeze (%) At time any 60 0 8X9 44-2* 18X3 41-2t 21-6 In past year 6-7 2-2 10-6 () 13-7 2-( Medication in past (%) year 42-2 156 462 15-4 47-1* 23-5 Antibiotics 37.8 13 3 423 14-4 43-1 19-6 Bronchodilators 11 1 4-4 10.6 4-8 118 3X9 Weeks off school for respiratory illness in past vear (mean (SD))4 1 4 (2-2) 0(7 (1-0) 18- (2 6) 0-8 (1-5) 2-4 (6-0) ()18 (1-1) No of general practitioner consultations for respiratory illness in past year (mean (SD))' 1-9 (2-5)t 0.9 (18) 1-6 0-8 (2-5) (1-3) 3-1 (8-6) 1-3 (2-)) Established asthma (%) 13-3 2-2 6-7 10( 7-8 5-9 Established bronchitis 0 0 (%) 4-8 0 3-9 P<0-01; tP<0l)5; tP<0l(X)(. Statistical McNemar's test. analysis, test; 4Wilcoxon Arch Dis Child: first published as 10.1136/adc.59.4.306 on 1 April 1984. Downloaded from http://adc.bmj.com/ on July 13, 2021 by guest. Protected by copyright. 308 Mok and Simpson Table 2 Respiratory function tests in relation to initial diagnosis Bronchiolitis Pneumonia Bronchitis (n = 44) In = 102) (n = 51) Index Control Index Control Inidex Control FEV in 0(75 sec (% predicted) 89f2 91-2 87.0 92 6 91 5 94.6 FEV in 1-0 sec (% 90(4 94-5 90.7t 94 8 93 3 95'7 predicted) FVC (% predicted) 83.7 86.6 86-2 86-4 88-7 88X6 (% predicted) 96 1 99.1 89-1 101 3 93 4f 107 2 FEF2575 FEV:FVC (09(0 (91 0(88 (091 0-89 (091 20(0 32-7 25-0 35-3 21 6 Fall in PEFR of 10% after exercise (%), 37-8 = = forced vital capacity; FEF2s7s = forced mid-expiratory flow (between 25% and 75% of FVC); PEFR = peak expiratory FEV forced expiratory volume; FVC flow rate. tP<0-05. Statistical analysis, Student's paired t !McNemar's test. .P<0-01; test; or Children with suffered. Thus sequelae after bronchitis pneu- dicted normal value for height. are less well documented than for bronchioli- reduction in forced monia bronchiolitis had a significant were increased in our in one and in three quarters tis. Respiratory symptoms expiratory volume index children, irrespective of the initial clinical flow of a second, forced mid-expiratory (between Although ventilatory function was un- and of forced vital capacity), and in forced diagnosis. 25% 75% equivocally reduced in children who suffered from volume in one second:forced vital expiratory bronchiolitis, a diminution in respiratory function capacity. Ventilatory function was also lower in was also observed in children who had had bronchi- bronchitis and pneumonia index children, but this statistical Bronchial tis or pneumonia. Failure to achieve did not reach statistical significance. the each index subgroup, significance may have been caused by relatively reactivity was increased in smaller number studied with the latter index but not As the numerical differences significantly. conditions. between index subgroups might have affected the It may be argued that separation of children on results obtained, an analysis of variance was diagnostic criteria based purely on clinical and performed between index children and controls radiological assessments is artifical, in view of the for each respiratory function variable measured. between the sub- observed within a considerable aetiological overlap This showed that the differences in differences between groups defined. There are also difficulties disting- disease category exceeded the with bronchiolitis from conclude uishing the infant presenting disease categories. We cannot, therefore, his first asthmatic attack, as viral that specific risk with regard to one suffering bronchiolitis confers are well known to precipitate ventilatory function, in view of the relatively smaller respiratory infections attacks of asthma.' 1 In assigning index children to a number of children studied with a history of diagnostic grouping Court's recommendations were bronchitis or pneumonia. followed strictly. Moreover, the pneumonia group Discussion by infants with proved bacterial was not weighted fewer than 14% infections-in each subgroup These results suggest that the outcome of acute of infants studied had bacterial isolates from lower respiratory tract infections in infancy is throat and nasal blood culture, or bacteriolo- swabs, illness suffered. unaffected by the type of index studies of tracheal aspirates, on the few gical mainly on the obtained. On the Previous workers have concentrated occasions when the latter were sequelae after acute bronchiolitis;68 others have findings it seems reasonable to basis of these attempted to differentiate acute infectious bron- that serious infections of the lower respira- postulate bronchiolitis that may repre- of chiolitis from sporadic tract during a 'vulnerable' period lung tory sent a first asthmatic attack.i't We had shown no have growth (whatever the clinical diagnosis) may differences in clinical characteristics and outcome contributed or indirectly to the subsequent directly of between children with proved respiratory syncytial increase in symptoms and impairment lung virus infection and those without,' but recognise function. that this virus could have been responsible for the We that the outcome for conclude, therefore, lack of illness in the latter group despite the acute lower respiratory tract infection severe to in the virological confirmation. enough to necessitate admission hospital To our there has been no previous is not the knowledge first year of life affected appreciably by relating outcome to the type of index illness of index illness suffered. A larger series is study type Arch Dis Child: first published as 10.1136/adc.59.4.306 on 1 April 1984. Downloaded from http://adc.bmj.com/ on July 13, 2021 by guest. Protected by copyright. Outcome for acute bronchitis, bronchiolitis, and pneumonia in infancy 309 necessary to settle whether bronchiolitis is more McNemar 0. Note on sampling error of the differences between correlated proportions or percentages. Psychometrika likely than bronchitis or pneumonia to be associated 1947;12:153-7. with abnormalities of ventilatory function in later Rooney JC, Williams HE. The relationship between proved childhood. viral bronchiolitis and subsequent wheezing. J Pediatr ;79:774-7. This study was supported by a generous grant from the Chest, 7 Sims DG, Downham MAPS, Gardner PS, et al. Study of 8 Heart, and Stroke Association. We thank Dr J M Inglis, Dr M year-old children with a of virus history respiratory syncytial Fulton, Miss C Jagger, and Mrs P Walker. We also thank general bronchiolitis in infancy. Br Med J 1978;i:11-4. practitioners for their cooperation, and all the children and parents 8 Pullan CR, Hey EN. Wheezing, asthma, and pulmonary who participated in the study. dysfunction 10 years after infection with respiratory syncytial virus in infancy. Br Med J 1982;284:1665-9. Simon G, Jordan WS. Infectious and of allergic aspects References bronchiolitis. J Pediatr 1967;70:533-8. 1 Mok JYQ, Simpson H. Outcome of acute lower respiratory 10 Polmar SH, Robinson LD, Minnefor AB. Immunoglobulin E in tract infection in infants: preliminary report of seven year bronchiolitis. Pediatrics 1972;50:279-84. follow-up study. Br Med J 1982;285:333-7. Berkovitch S, Millian SJ, Snyder RD. The association of viral 2 Mok JYQ, Simpson H. Symptoms, atopy, and bronchial and mycoplasma in in infections the recurrence of wheezing the reactivity after lower respiratory infection in infancy. Arch asthmatic child. Ann Allergy 1970;28:43-9. Dis Child 1984;59:299-305. Court SDM. The definition of acute respiratory illnesses in children. Postgrad Med J 1973;49:771-6. Correspondence to Professor H Simpson, University of Leicester, Clarke SKR, Gardner PS, Poole PM, et al. Respiratory syncytial Department of Child Health, Clinical Sciences Building, Leicester virus infection: admissions to hospital in industrial, urban and Royal Infirmary, Leicester LE2 7LX. rural areas. Report to the Medical Research Council subcom- mittee on respiratory syncytial virus vaccines. Br Med J Received 28 1978;ii:796-8. December 1983

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Archives of Disease in ChildhoodUnpaywall

Published: Apr 1, 1984

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