Causal Direction Between Respiratory Syncytial Virus Bronchiolitis and Asthma Studied in Monozygotic Twins

Background: Respiratory syncytial virus (RSV) bronchiolitis has been associated with later development of asthma, wheezing, abnormal pulmonary function, and sensitization. Our aim was to determine the differential effect within monozygotic (MZ) twin pairs discordant for severe RSV bronchiolitis in infancy on the subsequent development of asthma, pulmonary function, and allergy. Methods: Thirty-seven MZ twin pairs discordant for RSV hospitalization in infancy (mean age 10.6 months) were compared at the mean age of 7.6 years for lung function, bronchial responsiveness, fractional exhaled nitric oxide (FENO), asthma diagnosis, use of asthma medication, and skin prick test to common inhalant allergens. Results: There were no differences within MZ twin pairs discordant for RSV hospitalization in infancy with respect to pulmonary function, FENO, asthma prevalence, asthma medication use, or sensitization (P > .1 for all comparisons). Conclusions: We found no differential effect from severity of RSV infection on the development of asthma and allergy in MZ twin pairs discordant for RSV hospitalization in infancy. This argues against a specific effect of severe RSV infection in the development of asthma and allergy. Because of the small sample size, this study must be considered as a hypothesis-generating study. CHEST 2010; 138(2):338-344