| BACKGROUND:Bronchiolitis is the most frequent acute low respiratory tract infection disease in infants, characterized clinically by wheezing. 50%~80% of which is caused by respiratory syncytial virus (RSV), and many are infants less than 6 months old. The pathogenesis and imrnunopathogenesis have not been elucidated clearly, hence effective immunoprophylaxis and specific therapy for the RSV bronchiolitis are absent. Most of the patients with RSV bronchiolitis will recover through the clinical treatment, but the airway hyperresponsiveness appears in some of the patients, and some even develop recurrent wheezing and asthma. Some studies concluded that the wheezing of the bronchiolitis was the first episode of the asthma in fact, and recurrent wheezing , asthma followed. Therefore, it is closely related with asthma. The follow-up information in the overseas and home studies revealed that approximately42%~90% of the patients with bronchiolitis would show recurrent wheezing andasthma after RSV bronchiolitis.OBJECTIVE:To grasp the clinical characteristics of RSV bronchiolitis, comprehend the incidence of the recurrent cough and wheezing after RSV bronchiolitis and discuss the correlation factor of recurrent wheezing after RSV bronchiolitis. METHODSSummarize the clinical information from 150 hospitalized patients with the diagnosis of respiratory syncytial virus bronchiolitis from January 1, 2001 to December 31, 2002 in our hospital, and follow up was made.1-> The epidemiological and clinical information during hospitalization, including gender, age, personal atopy history (eczema, allergic rhinitis, drug allergy), family atopy history (asthma, eczema, allergic rhinitis, drug allergy), feeding practice, duration of wheezing, complications, dyspnoea (cyanosis, retraction sign), and the information of systemic glucocorticoids administration and glucocorticoids inhalation during hospitalization, were collected from the recorders.2> Follow-up: three ways were taken in the follow-up(telephone, letter, and visiting), to get the information of health and medication of the patients after they discharged, including cough more than 1 week, the second wheezing, and diagnosis as asthma. RESULTS:1 -, In our study , 150 children with RSV bronchiolitis were enrolled , in which119 were male and 31 female;with the mean aye of 4.7-~2.6 months. The personal atopy history was positive in 1 patient, only accounting for 0.7%, family history was positive in 6 patients (4.0%). Breastfeeding was done in 109 patients (72.7%). Mean duration of wheezing was 7.9±2.4 days, and 9 patients were severe (6.0%). Systemic glucocorticoids was taken in 71 patients (47.?%). IgE concentration in blood was evaluated in 16 patients, the results of 10 patients in which was >100IU/ml, accounting for 62.5%.2. 62 patients were followed. There were 53 male and 9 female in these patients. The mean age was 5.1±2.6 months. The personal atopy history was positive in 1 patient (1.6%), and family history was positive in 3 patients (4.8%). Breastfeeding was done in 43 patients (69.4%). Mean duration of wheezing was 7.4±2.7 days, and 5 patients were severe (8.1%). Systemic glucocorticoids was taken in 28 patients (45.2%). IgE concentration in blood was evaluated in 8 patient which finished the follow-up, the results of 7 patients in which was > 1 OOIU/ml, accounting for 87.5%.3 ^ In the 62 patients which were followed completely, 41 patients coughed more than 1 week, 26 patients had second wheezing, 12 patients were diagnosed as asthma, respectively accounting for 66.1%,41.9% and 19.4%. 44 patients had one or more of the above symptoms, accounting for 71.0%.4^ The mean age of the patients who coughed more than 1 week after RSV bronchiolitis was 5.0±2.8 months, and the mean age of the patients without the symptom was 5.4±2.4 months. There was no significant difference (t=0.603, P>0.05) between these two groups. The mean age of those with second wheezing was 4.8±3.0months, and the mean age of those without was 5. ■'■~2.4 months. There was no significant difference (t=0.626. P>0.05) between these two groups. The mean age of the patients who were diagnosed asthma was 3. Si 19 months, and the mean age of the other group was 5.5±2.7 months. The former was significantly younger than the latter (t=2.424, P<0.05). The mean age of the group with any of the above symptoms was 5.1±2.8 months, and 5.0±2.2 months in the other group. There was no significant difference (t=0.183. P>0.05) between these two groups.5 -, In the patients followed completely, only I patient had positive allergic history, and coughed more than 1 week, but denied second wheezing and asthma. In the other 61 patients without allergic history, there were 40, 26 and 12 patients respectively ,who coughed more than 1 week, had second wheezmg and diagnosed as asthma, accounting for 65.6%, 42.6% and 19.7%. 43 patients had one or more of the above symptoms, accounting for 70.5%.6-. In the patients followed completely, 3 patients had positive family atopy history. There were 3, 1 and 1 patients respectively, who coughed more than 1 week, had second wheezing and diagnosed as asthma, respectively accounting for 100%, 33.3% and 33.3%. All the 3 patients had one or more of the above symptoms, accounting for 100%. The other 59 patients had negative family atopy history, and there were 38, 25 and 11 patients respectively, who coughed more than 1 week, had second wheezing and diagnosed as asthma, respectively accounting for 64.4%, 42.4% and 18.6%. 41 patients had one or more of the above symptoms, accounting for 69.5%.There was no significant difference in any parameter between these two groups(X'-'was 1.615, 0.096, 0.395 and 1.290 respecrvely, P>0.05).7s In the cases followed completely, 43 patients were maternal breast-fed, in which the number of cases with cough more than I week, second wheezing or diagnosed as asthma were 27, 17 and 7, accounting for 62.8%, 39.5% and 16.3%. 19 patients were non-maternal breast-fed, in which the number of cases with different conditions as mentioned were 14, 9 and 5, accounting for 73.7%, 47.4% and 26.3%. There was no significant difference in any parameter between groups. ( The X" value was 0.698, 0.332 and 0.850, P>0.05). There were 31 patients(72.1%) who had one or more symptoms mentioned above among the maternal breast-fed patients, compared with 13 cases(68.4%) in non-matemal breast-fed patients with no significant difference between these two groups. (The X"' value was 0.086, P>0.05)8^ In the cases followed completely, 57 patients were mild, in which the number of cases with cough more than 1 week, second wheezing and diagnosed as asthma was 37, 23 and 10 , accounting for 64.9%, 41.5% and 17.5%. 5 patients were severe, in which the number of cases with different conditions as mentioned was 4, 3 and 2, accounting for 80.0%, 60.0% and 40.0%. There was no significant difference in any parameter between groups. ( The X" value was 0.467, 0. 729 and 1.485, P>0.05). There were 40 patients(70.2%) who had one or more symptoms mentioned above among the mild patients, compared with 4 cases(80.0%) in severe patients with no significant difference between these two groups. (The X2 value was 0.215, P>0.05)9. In the patients followed completely, 28 patients took systemic glucocorticoids, in which 16 patients coughed more than 1 week after RSV bronchiolitis, accountingfor 57.1%. In the other 34 patients, 25 patients joughed more than 1 week after RSV bronchiolitis, accounting for 73.5%. There was no significant difference (X'= 1.841, P>0.05) between these two groups. 7 patients who taken systemic glucocorticoids had second wheezing after RSV bronchiolitis, accounting for 25.0%;19 patients in the patients who did not take systemic glucocorticoids had second wheezing after RSV bronchiolitis, accounting for 55.5%. The latter was significantly higher than the former (XJ=6.014 , P<0.05). 4 patients in the patients who taken systemic glucocorticoids were diagnosed as asthma after RSV bronchiolitis, accounting for 14.3%;8 patients in the patients without taking systemic glucocorticoids were diagnosed as asthma after RSV bronchiolitis, accounting for 23.5%. There was no significant difference (XJ=0.841, P>0.05) between these two groups. 16 of the patients who taken systemic glucocorticoids had one or more of the above symptoms (57.1%), and 28 of the patients without taking systemic glucocorticoids had one or more of the above symptoms (82.4%).The difference between these two groups was significant (X2=4.736, PO.05).1(K In the patients followed completely, only 8 patients took the blood IgE concentration evaluation, 7 with elevated level. In those with elevated IgE, there were 4, 2 and 1 patients respectively who coughed more than 1 week, had second wheezing and diagnosed as asthma, accounting for 57.1%, 28.6% and 14.3%. 4 patients had one or more of the above symptoms, accounting for 57.1%. Only one child had normal blood IgE concentration and he did not develop recurrent cough or wheezing or asthma after RSV bronchiolitisCONCLUSIONS:1■, RSV bronchiolitis shows peak incidence during waiter with male predominated. Its meanage was 4.7±2.6months. The prognosis in acute stage is well. 2. Approximately 71.0% of the children 3 years after RSV bronchiolitis had therecurrent cough and or wheezing. 66.1% coughed more than 1 week, 41.9% hadsecond wheezing , and 19.4% were diagnosed as asthma.3^ Those infants of RSV bronchiolitis with younger age more easily develop asthma. 4> Systemic glucocorticoid administration in the acute phase of RSV bronchiolitisreduces the incidence of second wheezing post-bronchiolitis. 5> The relationship between post-bronchiolitis recurrent cough or wheezing andgender, personal allergic history, family atopy history, breastfeeding, or severityhasn't been found. |
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