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Key risk factors of asthma-like symptoms are mediated through infection burden in early childhood - 08/03/24

Doi : 10.1016/j.jaci.2023.11.019 
Julie Nyholm Kyvsgaard, MD a, b, Nicklas Brustad, MD, PhD a, Laura Marie Hesselberg, MD a, Nilo Vahman, MD, PhD a, Jonathan Thorsen, MD, PhD a, Ann-Marie Malby Schoos, MD, PhD a, b, Klaus Bønnelykke, MD, PhD a, Jakob Stokholm, MD, PhD a, b, c, , Bo Lund Chawes, MD, PhD, DMSc a,
a Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark 
b Department of Pediatrics, Slagelse Hospital, Slagelse, Denmark 
c Section of Microbiology and Fermentation, Department of Food Science, University of Copenhagen, Copenhagen, Denmark 

Corresponding author: Bo Lund Chawes, MD, PhD, DMSc, Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Ledreborg Alle 34, 2820 Gentofte, Denmark.Copenhagen Prospective Studies on Asthma in Childhood (COPSAC)Department of PediatricsHerlev and Gentofte HospitalUniversity of CopenhagenLedreborg Alle 34Gentofte2820Denmark

Abstract

Background

Risk factors of asthma-like symptoms in childhood may act through an increased infection burden because infections often trigger these symptoms.

Objective

We sought to investigate whether the effect of established risk factors of asthma-like episodes in early childhood is mediated through burden and subtypes of common infections.

Methods

The study included 662 children from the Copenhagen Prospective Studies on Asthma in Childhood 2010 mother-child cohort, in which infections were registered prospectively in daily diaries from age 0 to 3 years. The association between established risk factors of asthma-like episodes and infection burden was analyzed by quasi-Poisson regressions, and mediation analyses were performed for significant risk factors.

Results

In the first 3 years of life, the children experienced a median of 16 (interquartile range, 12-23) infectious episodes. We found that the infection burden significantly (PACME < .05) mediated the association of maternal asthma (36.6% mediated), antibiotics during pregnancy (47.3%), siblings at birth (57.7%), an asthma exacerbation polygenic risk score (30.6%), and a bacterial airway immune score (80.2%) with number of asthma-like episodes, whereas the higher number of episodes from male sex, low birth weight, low gestational age, and maternal antibiotic use after birth was not mediated through an increased infection burden. Subtypes of infections driving the mediation were primarily colds, pneumonia, gastroenteritis, and fever, but not acute otitis media or acute tonsillitis.

Conclusions

Several risk factors of asthma-like symptoms in early childhood act through an increased infection burden in the first 3 years of life. Prevention of infectious episodes may therefore be beneficial to reduce the burden of asthma-like symptoms in early childhood.

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Key words : Respiratory signs and symptoms, cough, dyspnea, wheezing, risk factors, infection, infant, preschool child, mediation analysis

Abbreviations used : ACME, AOM, COPSAC2010, C-section, FUT2, ICS, IQR, IRR, 25(OH)D, PRS, RTI


Plan


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© 2023  The Authors. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 153 - N° 3

P. 684-694 - mars 2024 Retour au numéro
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