Viral Inception of Asthma: Prospective Study From Infancy to School-age
Status:
Unknown status
Trial end date:
1969-12-31
Target enrollment:
Participant gender:
Summary
The purpose of this study is to study prospectively the early clinical and immunological
events in children susceptible to rhinovirus induced early wheezing (i.e., recently found
highest risk factor for recurrent wheezing/asthma) and the efficacy of systemic
corticosteroid to modify these events.
Up to 50% of children suffer from acute wheezing before school-age. The prevalence of
childhood asthma is 5-7%. Although pediatric asthma is mainly allergic, the exacerbations are
associated with respiratory viral infections in 95% of cases. The means to predict asthma
from environmental factors have been limited mainly to sensitization to aeroallergens (3-fold
risk), which start to develop usually at 2-3 years of age. VINKU 1-study (orig. VINKU-study)
discovered simultaneously with two other groups, that early wheezing associated with
rhinovirus, the "common cold" virus, is the strongest predictor of recurrent wheezing/asthma
(up to 10-fold risky). Noteworthily, viral infections work as risk markers already during
infancy, a lot earlier than the sensitization to aeroallergens. The investigators also found
retrospectively that early wheezers affected by rhinovirus responded to 3 day course of oral
prednisolone (inexpensive and widely available treatment): recurrent wheezing decreased by
50% during following 12 months and the difference appeared to continue. VINKU 5V-study is
currently investigating the clinical history, prevalence of asthma and airway hyperreactivity
of these same children at school-age. The mechanism of rhinovirus associated risk or why they
respond to prednisolone are largely unknown. However, the susceptibility to rhinovirus
infections is associated with atopy and therefore it is possible these children may have
impaired anti-inflammatory (Treg) responses and more likely to wheeze with any
pro-inflammatory response (Th1 or Th2). Moreover, they may not effectively clear viruses,
because they can not limit rhinovirus to nose and it spreads to lower airways and causes
wheezing. VINKU 2-study will prospectively investigate the immunological events in young
first-time wheezers affected by rhinovirus, and prospectively study the clinical efficacy of
systemic corticosteroid in them. Most likely these children will benefit from the drug in
terms of less recurrent wheezing, the investigators will also explore immunological effects
of the drug and their link to clinical efficacy. The results are expected to give basis for
the prevention of asthma and for the development of new treatment strategies and they can be
directly applied to clinical medicine.
Phase:
N/A
Details
Lead Sponsor:
University of Turku
Collaborators:
Cultural Foundation of Finland, Helsinki, Finland Foundation for outpatient Research, Helsinki, Finland Foundation for Paediatric Research, Finland Juselius Foundation, Helsinki, Finland Maud Kuistila Foundation, Helsinki, Finland Research Support, Turku University Hospital, Turku, Finland The Paulo Foundation