Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology · 2026
Duration and severity of asthma-like episodes in young children vary by viral and bacterial triggers.
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Kyvsgaard Julie Nyholm, Thorsen Jonathan, Jensen Signe Kjeldgaard, Sultan Tamo, Brustad Nicklas, Pedersen Casper-Emil Tingskov, Kjellberg Anton, Fischer Thea K, Krogfelt Karen A, Vahman Nilo, Gern James E, Schoos Ann-Marie Malby, Bønnelykke Klaus, Chawes Bo Lund, Stokholm Jakob
Аннотация
BACKGROUND: Asthma-like episodes with cough, wheeze and/or breathlessness are frequent in young children and often triggered by respiratory tract infections. We aimed to examine whether specific microbial triggers of asthma-like episodes were associated with episode duration and severity.
METHODS: We analyzed 453 nasopharyngeal aspirates collected during acute asthma-like episodes from 268 children aged 0-3 years from the COPSAC-2010 cohort. Samples were tested for common pathogenic respiratory viruses by PCR and for bacteria by culture. Asthma-like episodes were prospectively recorded in diaries. Associations between microbial triggers and episode duration and severity were analyzed by generalized estimating equations. Interactions between microbial triggers and selected asthma risk loci and polygenic risk scores (PRSs) were explored in relation to episode duration.
RESULTS: Rhinovirus was associated with 27% longer episode duration compared to episodes without rhinovirus, predominantly driven by rhinovirus C (50% longer). Rhinovirus was also associated with a more than twofold increased risk of a severe asthma exacerbation (i.e., need for oral prednisolone, high-dose inhaled corticosteroids, and/or hospitalization) (OR 2.26; 95% CI 1.10-4.64; p = .027), with rhinovirus C exhibiting an even higher risk (OR 4.38; 95% CI 1.71-11.25; p = .002). Episodes with Streptococcus pneumoniae, Haemophilus influenzae, and/or Moraxella catarrhalis were associated with 61% longer duration than episodes without these bacteria, which was particularly pronounced for M. catarrhalis (47% longer). In contrast, RSV; parainfluenza and influenza viruses were associated with shorter duration. Younger age correlated with longer episode duration and risk of a severe asthma exacerbation. Exploratory analyses suggested pathogen-specific interactions with selected asthma risk loci and asthma exacerbartion PRS in relation to episode duration.
CONCLUSION: Specific microbial triggers and younger age were associated with the duration and severity of asthma-like episodes in young children. These findings may improve prognostic assessment and support more individualized management.
METHODS: We analyzed 453 nasopharyngeal aspirates collected during acute asthma-like episodes from 268 children aged 0-3 years from the COPSAC-2010 cohort. Samples were tested for common pathogenic respiratory viruses by PCR and for bacteria by culture. Asthma-like episodes were prospectively recorded in diaries. Associations between microbial triggers and episode duration and severity were analyzed by generalized estimating equations. Interactions between microbial triggers and selected asthma risk loci and polygenic risk scores (PRSs) were explored in relation to episode duration.
RESULTS: Rhinovirus was associated with 27% longer episode duration compared to episodes without rhinovirus, predominantly driven by rhinovirus C (50% longer). Rhinovirus was also associated with a more than twofold increased risk of a severe asthma exacerbation (i.e., need for oral prednisolone, high-dose inhaled corticosteroids, and/or hospitalization) (OR 2.26; 95% CI 1.10-4.64; p = .027), with rhinovirus C exhibiting an even higher risk (OR 4.38; 95% CI 1.71-11.25; p = .002). Episodes with Streptococcus pneumoniae, Haemophilus influenzae, and/or Moraxella catarrhalis were associated with 61% longer duration than episodes without these bacteria, which was particularly pronounced for M. catarrhalis (47% longer). In contrast, RSV; parainfluenza and influenza viruses were associated with shorter duration. Younger age correlated with longer episode duration and risk of a severe asthma exacerbation. Exploratory analyses suggested pathogen-specific interactions with selected asthma risk loci and asthma exacerbartion PRS in relation to episode duration.
CONCLUSION: Specific microbial triggers and younger age were associated with the duration and severity of asthma-like episodes in young children. These findings may improve prognostic assessment and support more individualized management.