Document Type : Original Article
Authors
- . Mohammadreza Modaresi
- . Ali Pourvali 1
- . Gholamreza Azizi 2
- . Reza Rezaee Taher 3
- . Tina Alinia 4
- . Mohsen Reisi 1
1 Department of Pediatric Pulmonology, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
2 NonCommunicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran,
3 Department of Pediatrics, Ziaeian Hospital, Tehran University of Medical Sciences, Teharan, Iran,
4 Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children’s Medical Center, Tehran University of Medical Science, Tehran, Iran
Abstract
BACKGROUND: Some evidence suggests that childhood croup could be associated with increased
incidence of adulthood bronchial reactivity, but its significance is uncertain. The aim of the present
study was to evaluate the long‑term outcome of early life croup.
PATIENTS AND METHODS: This case–control study was conducted in 2010–2012 in Isfahan,
Iran. The case group consisted of 164 adolescents with a history of severe croup in early life and an
equal number of healthy controls without any history of croup or other chronic or recurrent respiratory
diseases. The two groups were compared according to pulmonary function tests and bronchial
reactivity (exercise challenge test). Statistical analyses were performed using the SPSS software
package, version 20 (SPSS Inc., Chicago, IL, USA). P < 0.05 was considered significant.
RESULTS: Baseline spirometric values (forced expiratory volume in 1st s (FEV1), forced volume
capacity (FVC), FEV1/FVC, and forced expiratory flow at 25%–75% (FEF25–75) were similar in case
and control groups. A reduction in FEV1 and FEF25–75 after exercise challenge test was seen in
9% and 12.8% of patients, respectively, whereas this was reduced in only 4.2% and 6.1% of the
controls (P = 0.034 and P = 0.021, respectively).
CONCLUSION: Our findings suggest that childhood croup might be a predisposing factor for bronchial
hyperreactivity in adulthood. Longitudinal studies are necessary to confirm the clinical significance
of these findings.
Keywords
2. Kwong K, Hoa M, Coticchia JM. Recurrent croup presentation,
diagnosis, and management. Am J Otolaryngol 2007;28:401‑7.
3. Moussa MA, Skaik MB, Yaghy OY, Salwanes SB, Bin‑Othman SA.
Factors associated with asthma in school children. Eur J Epidemiol
1996;12:583‑8.
4. Mazza D, Wilkinson F, Turner T, Harris C, Health for Kids
Guideline Development Group. Evidence based guideline for
the management of croup. Aust Fam Physician 2008;37:14‑20.
5. Arshad SH, Kurukulaaratchy RJ, Fenn M, Matthews S. Early life
risk factors for current wheeze, asthma, and bronchial hyper
responsiveness at 10 years of age. Chest 2005;127:502‑8.
6. Kivity S, Agmon‑Levin N, Blank M, Shoenfeld Y. Infections and
autoimmunity‑friends or foes? Trends Immunol 2009;30:409‑14.
7. Nafstad P, Magnus P, Jaakkola JJK. Early respiratory infections
and childhood asthma. Pediatrics 2000;106:E38.
8. Björkstén B. The hygiene hypothesis: Do we still believe in it?
Nestle Nutr Workshop Ser Pediatr Program 2009;64:11‑8.
9. Segal AO, Crighton EJ, Moineddin R, Mamdani M, Upshur RE.
Croup hospitalizations in Ontario: A 14‑year time‑series analysis.
Pediatrics 2005;116:51‑5.
10. Illi S, von Mutius E, Lau S, Bergmann R, Niggemann B,
Sommerfeld C, et al. Early childhood infectious diseases and the
development of asthma up to school age: A birth cohort study.
BMJ 2001;322:390‑5.
11. Nafstad P, Brunekreef B, Skrondal A, Nystad W. Early respiratory
infections, asthma, and allergy: 10‑year follow‑up of the Oslo birth
cohort. Pediatrics 2005;116:e255‑62.
12. Balemans WA, Rovers MM, Cornelis K. Childhood upper
respiratory tract infections are not associated with asthma, hay
fever and eczema at adulthood: A birth cohort study. Eur Respir
J 2004;24 Suppl 48:40.
13. Mulholland A, Ainsworth A, Pillarisetti N. Tools in Asthma
evaluation and management: When and how to use them? Indian
J Pediatr 2017. [Epub ahead of print].
14. Akinbami LJ, Moorman JE, Bailey C, Zahran HS, King M,
Johnson CA, et al. Trends in asthma prevalence, health care use,
and mortality in the united states, 2001‑2010. NCHS Data Brief
2012;94:1‑8.
15. Hassanzadeh J, Mohammadbeigi A, Mousavizadeh A, Akbari M.
Asthma prevalence in Iranian guidance school children, a
descriptive meta‑analysis. J Res Med Sci 2012;17:293‑7.
16. Castro-Rodriguez JA, Holberg CJ, Morgan WJ, Wright AL,
Halonen M, Taussig LM, et al. Relation of two different subtypes
of croup before age three to wheezing, atopy, and pulmonary
function during childhood: A prospective study. Pediatr Am J
Rhinol 2006;20:53‑63.
17. Lin SC, Lin HW, Chiang BL. Association of croup with asthma
in children: A cohort study. Medicine (Baltimore) 2017;96:e7667.
18. Nicolai T, Mutius EV. Risk of asthma in children with a history
of croup. Acta Paediatr 1996;85:1295‑9.
19. Van Bever HP, Wieringa MH, Weyler JJ, Nelen VJ, Fortuin M,
Vermeire PA, et al. Croup and recurrent croup: Their association
with asthma and allergy. An epidemiological study on
5‑8‑year‑old children. Eur J Pediatr 1999;158:253‑7.
20. Sposato B. Predicted values for spirometry may underestimate
long‑standing asthma severity. Open Respir Med J 2016;10:70‑8.
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