Etiology and Severity of Infant Bronchiolitis and Development of Childhood Asthma

描述（由申请人提供）：该候选人是一名内科流行病学家，专注于环境因素的相互作用，特别是儿童早期病毒感染，以及它们如何促进哮喘的发展。候选人将通过参加免疫学、微生物学和流行病学课程以及参加临床会议来增加她在哮喘、特应性反应和流行病学方面的知识。候选人将在导师和咨询委员会的指导下进行拟议的研究，该委员会在与项目相关的所有领域都具有专业知识。该建议的目标是培养候选人进行前瞻性和回顾性流行病学调查，特别是调查婴儿期细支气管炎和哮喘发展的作用。观察性研究报道，超过30%的呼吸道合胞病毒（RSV）毛细支气管炎住院婴儿随后发展为哮喘。然而，尚不清楚毛细支气管炎的严重程度或病毒病因是否与哮喘风险增加有关。也不知道哮喘的两个危险因素——哮喘的家族易感性和环境烟草烟雾（ETS）——是如何与细支气管炎相互作用而影响哮喘风险的。候选人将验证以下假设：(a)任何严重程度的临床显著性细支气管炎均与哮喘发病风险增加相关，更严重的细支气管炎与更大的哮喘发病风险相关；(b) RSV与非RSV呼吸道病毒对儿童哮喘发病风险的影响不同；(c)家庭环境相互作用可改变哮喘发病风险。在Specific Aim #1中，候选人将使用田纳西州医疗补助数据进行一项基于人群的回顾性队列研究，以确定5岁时RSV和非RSV病因（包括住院和门诊）与哮喘的关系。在Specific Aim #2中，候选人将对一项正在进行的前瞻性队列（特应性-细支气管炎队列）的随访延长至5岁，该队列包括在婴儿期因细支气管炎住院或门诊就诊的婴儿，以确定病毒病因和细支气管炎严重程度是否与哮喘发展独立相关。研究结果将确定哪些婴儿患哮喘的风险最大，哪些可改变的因素与毛细支气管炎相互作用以增加风险，从而指导未来在婴儿期预防或治疗措施的应用和评估。

DESCRIPTION (provided by applicant): The candidate is a physician-epidemiologist who focuses on the interaction of environmental factors, specifically viral infections in early childhood, and how they contribute to the development of asthma. The candidate will increase her knowledge of asthma, atopy, and epidemiology by attending courses in immunology, microbiology and epidemiology, and by attending clinical conferences. The candidate will conduct the proposed research under the guidance of mentors and an advisory committee who have expertise in all areas related to the project. The goals of this proposal are to train the candidate to do prospective and retrospective epidemiologic investigations, and specifically to investigate the role of bronchiolitis during infancy and the development of asthma. Observational studies have reported that over 30% of hospitalized infants with Respiratory Syncytial Virus (RSV) bronchiolitis subsequently develop asthma. However, it is not known whether the severity or viral etiology of bronchiolitis is associated with increased asthma risk. Neither is it known how two risk factors for asthma, familial predisposition to develop asthma and environmental tobacco smoke [ETS], interact with bronchiolitis to affect asthma risk. The candidate will test the hypothesis that (a) clinically significant bronchiolitis of any severity is associated with increased risk of developing asthma, with more severe bronchiolitis associated with greater asthma risk and that (b) RSV vs. non-RSV respiratory viruses confer different risks on the development of childhood asthma, and that (c) familial-environment interactions modify the risk of developing asthma. In Specific Aim #1, the candidate will conduct a retrospective population-based cohort study using Tennessee Medicaid data to determine the association of bronchiolitis of RSV and non-RSV etiology, including inpatient and outpatient care, with asthma at age 5 years. In Specific Aim #2, the candidate will extend follow-up to age 5 years of an ongoing prospective cohort (Atopy-Bronchiolitis Cohort) of infants with either a hospitalization or outpatient visit for bronchiolitis during infancy to determine whether viral etiology and bronchiolitis severity are independently associated with asthma development. Findings will identify infants who are at the greatest risk for developing asthma, what modifiable factors interact with bronchiolitis to increase the risk, and thus guide the future application and evaluation of preventive or treatment measures during infancy.