Etiology and Severity of Infant Bronchiolitis and Development of Childhood Asthma

应聘者描述(由申请人提供)：应聘者是一名医生兼流行病学家，主要研究环境因素的相互作用，特别是儿童早期的病毒感染，以及它们如何促进哮喘的发展。应聘者将通过参加免疫学、微生物学和流行病学的课程以及参加临床会议来增加她对哮喘、变态反应和流行病学的知识。候选人将在导师和咨询委员会的指导下进行拟议的研究，这些顾问和咨询委员会拥有与项目相关的所有领域的专业知识。这项建议的目标是培训候选人进行前瞻性和回溯性的流行病学调查，特别是调查毛细支气管炎在婴儿期和哮喘发展中的作用。观察性研究报告称，超过30%患有呼吸道合胞病毒(RSV)毛细支气管炎的住院婴儿随后会发展为哮喘。然而，尚不清楚毛细支气管炎的严重性或病毒病因是否与哮喘风险增加有关。目前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]--如何与毛细支气管炎相互作用而影响哮喘风险。候选人将测试以下假设：(A)临床上任何严重的毛细支气管炎都与发生哮喘的风险增加相关，更严重的毛细支气管炎与更高的哮喘风险相关，(B)呼吸道合胞病毒与非呼吸道合胞病毒对儿童哮喘的发展具有不同的风险，以及(C)家庭与环境的相互作用会改变发生哮喘的风险。在具体目标#1中，候选人将利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，以确定呼吸道合胞病毒毛细支气管炎和非呼吸道合胞病毒病因(包括住院和门诊护理)与5岁时哮喘的相关性。在具体目标#2中，候选人将继续对在婴儿期因毛细支气管炎住院或门诊的婴儿进行前瞻性队列(特应性毛细支气管炎队列)的随访至5岁，以确定病毒病因和毛细支气管炎的严重程度是否与哮喘的发展独立相关。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增加风险，从而指导未来对婴儿时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.