598 THE EFFECT OF VIRAL LOWER RESPIRATORY TRACT INFECTION IN INFANCY ON PULMONARY FUNCTION IN CHILDHOOD PROSPECTIVE STUDY

Abstract

A group of infants who developed bronchiolitis in the first 18 months of life and a control group of normal infants were followed from birth through six years of age in order to determine the effects of viral infections on long-term lung development. Epidemiologic data concerning family history of atopic disease, breast-feeding and exposure of subjects to cigarette smoke were obtained. At age 5 to 6 years, subjects had detailed pulmonary function testing. Over 70% of the infants with bronchiolitis developed recurrent episodes of wheezing during the study period. No single factor was predictive of the development of bronchiolitis or wheezing. However, breast-feeding, exposure to cigarette smoke in the home and magnitude of cell-mediated immune response to respiratory syncytial virus (RSV) at the time of primary RSV infection were strongly predictive of the development of recurrent wheezing and/or number of episodes of wheezing. When tested at 5 to 6 years of age, over 157, of the bronchiolitis group had reduced FEF_25-75 and/or reduced FEF₅₀ (less than 60% of expected for age) while none of the controls had such a reduction. RV/TLC ratios were increased (>1.75) in 26% of bronchiolitis patients vs. 4% of controls (0.1>p>0.05). These data indicate that intrinsic as well as environmental factors determine the frequency with which wheezing episodes occur in early childhood and may have some effect on development of the small airway.

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