Abstract
BACKGROUND: Pathological features of the airway in young children with severe recurrent wheeze suggest an association between bacterial colonization and the initiating events of early asthma. We conducted a study to investigate a possible association between bacterial colonization of the hypopharynx in asymptomatic neonates and later development of recurrent wheeze, asthma, and allergy during the first 5 years of life.
METHODS: The subjects were children from the Copenhagen Prospective Study on Asthma in Childhood birth cohort who were born to mothers with asthma. Aspirates from the hypopharyngeal region of asymptomatic 1-month-old infants were cultured for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. Wheeze was monitored prospectively on diary cards during the first 5 years of life. Blood eosinophil count and total IgE and specific IgE were measured at 4 years of age. Lung function was measured and asthma was diagnosed at 5 years of age.
RESULTS: Hypopharyngeal samples were cultured from 321 neonates at 1 month of age. Twenty-one percent of the infants were colonized with S. pneumoniae, M. catarrhalis, H. influenzae, or a combination of these organisms; colonization with one or more of these organisms, but not colonization with S. aureus, was significantly associated with persistent wheeze (hazard ratio, 2.40; 95% confidence interval [CI], 1.45 to 3.99), acute severe exacerbation of wheeze (hazard ratio, 2.99; 95% CI, 1.66 to 5.39), and hospitalization for wheeze (hazard ratio, 3.85; 95% CI, 1.90 to 7.79). Blood eosinophil counts and total IgE at 4 years of age were significantly increased in children colonized neonatally with S. pneumoniae, M. catarrhalis, H. influenzae, or a combination of these organisms, but specific IgE was not significantly affected. The prevalence of asthma and the reversibility of airway resistance after beta2-agonist administration at 5 years of age were significantly increased in the children colonized neonatally with these organisms as compared with the children without such colonization (33% vs. 10% and 23% vs. 18%, respectively).
CONCLUSIONS: Neonates colonized in the hypopharyngeal region with S. pneumoniae, H. influenzae, or M. catarrhalis, or with a combination of these organisms, are at increased risk for recurrent wheeze and asthma early in life.
Original language | English |
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Journal | The New England Journal of Medicine |
Volume | 357 |
Issue number | 15 |
Pages (from-to) | 1487-95 |
Number of pages | 9 |
ISSN | 0028-4793 |
DOIs | |
Publication status | Published - 11 Oct 2007 |
Bibliographical note
Copyright 2007 Massachusetts Medical Society.Keywords
- Asthma/drug therapy
- Bacterial Infections/complications
- Bronchodilator Agents/therapeutic use
- Budesonide/therapeutic use
- Child, Preschool
- Cohort Studies
- Female
- Haemophilus influenzae/isolation & purification
- Humans
- Hypersensitivity/microbiology
- Hypopharynx/microbiology
- Immunoglobulin E/blood
- Infant
- Infant, Newborn
- Kaplan-Meier Estimate
- Male
- Moraxella catarrhalis/isolation & purification
- Neutrophils/physiology
- Respiratory Sounds/etiology
- Respiratory Tract Infections/complications
- Risk Factors
- Staphylococcus aureus/isolation & purification
- Streptococcus pneumoniae/isolation & purification