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

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  • Julie Nyholm Kyvsgaard
  • Nicklas Brustad
  • Laura Marie Hesselberg
  • Nilo Vahman
  • Jonathan Thorsen
  • Ann Marie Malby Schoos
  • Klaus Bønnelykke
  • Stokholm, Jakob
  • Bo Lund Chawes

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.

Original languageEnglish
JournalJournal of Allergy and Clinical Immunology
Volume153
Issue number3
Pages (from-to)684-694
Number of pages11
ISSN0091-6749
DOIs
Publication statusPublished - 2024

Bibliographical note

Publisher Copyright:
© 2023 The Authors

    Research areas

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

ID: 386160839