Table 4. Summary of evidence for asthma associated with RSV infection among within-study population comparisons.
| Outcome | Comparator 1 | Comparator 2 | FU | Study design (no. of studies); Sample size |
Absolute difference (95% CI) | Relative risk (95% CI) |
Certainty of evidence | Conclusion | |
|---|---|---|---|---|---|---|---|---|---|
| Comparator 2 risk | Absolute risk differencea | ||||||||
| Asthma; physician-diagnosed | |||||||||
| Not-at-risk population | RSV infection in first year of life | Infection with a respiratory pathogen other than RSV in first year of life | 7 y | PC31 (n=1); 329 |
12 per 100 | 15 more per 100 (4–35 more) |
RR 2.33 (1.35, 4.05) Adjusted for total number of respiratory episodes: OR 1.26 (0.54, 2.91), p=0.59 |
Very lowb,c,d,e |
Very uncertain For physician-diagnosed asthma at seven years of age among healthy infants with RSV vs. a different respiratory pathogen in the first year of life |
| Not-at-risk population | RSV-H | No RSV-H | 28–31 y | PC28 (n=1); 129 |
13 per 100 | NS | RR 1.82 (0.84, 3.94) |
Very lowb,c,e |
Very uncertain For physician-diagnosed asthma at 28–31 years of age among term infants with vs. without hospitalization for RSV at age <24 months |
| Asthma; self-reported | |||||||||
| Not-at-risk population | RSV-H | No RSV-H | 17–20 y; 28–31 y |
PC27,28 (n=2); 203 |
15 per 100 | 19 more per 100 (0.1–60 more) |
RR 2.28 (1.01, 5.12) |
Lowb,e |
Small increase For self-reported asthma in adulthood (17–31 years of age) among infants with vs. without hospitalization for RSV at age <24 months |
| Asthma medication (bronchodilator) | |||||||||
| At-risk with RSV-H vs. at-risk without RSV-H | Prematurity: 32–35 wGA, RSV-H |
Prematurity: 32–35 wGA, No RSV-H |
Across 2–6 y | PC32 (n=1); 487 |
17 per 100 | 8 more per 100 (4–13 more) |
RR 1.48 (1.23, 1.77) |
Lowc,e |
Small increase Parent-reported bronchodilator use from 2–6 years of age among infants born premature (32–35 wGA) with vs. without hospitalization for RSV at <12 months |
| Not-at-risk population | RSV-H | No RSV-H | 28–31 y | PC28 (n=1); 129 |
14 per 100 | 16 more per 100 (1–47 more) |
RR 2.17 (1.08, 4.34) |
Very lowb,c,e |
Very uncertain For self-reported bronchodilator use in adulthood (28–31 years of age) among term infants with vs. without hospitalization for RSV at age <24 months |
| Asthma medication (inhaled CS) | |||||||||
| At-risk with RSV-H vs. at-risk without RSV-H | Prematurity: 32–35 wGA, RSV-H |
Prematurity: 32–35 wGA, No RSV-H |
Across 2–6 y | PC32 (n=1); 487 |
16 per 100 | 10 more per 100 (2–22 more) |
RR 1.65 (1.13, 2.40) |
Lowc,e |
Small increase Parent-reported ICS use from 2–6 years of age among infants born premature (32–35 wGA) with hospitalization for RSV at <12 months |
| Not-at-risk population | RSV-H | No RSV-H | 28–31 y | PC28 (n=1); 129 |
11 per 100 | NS | RR 1.56 (0.62, 3.89) |
Very lowb,c,e |
Very uncertain For self-reported ICS use in adulthood (28–31 years of age) among term infants with vs. without hospitalization for RSV at age <24 months |
| Asthma medication (oral CS) | |||||||||
| At-risk with RSV-H vs. at-risk without RSV-H | Prematurity: 32–35 wGA, RSV-H |
Prematurity: 32–35 wGA, No RSV-H |
Across 2–6 y | PC32 (n=1); 487 |
11 per 100 | 8 more per 100 (0.6–19 more) |
RR 1.71 (1.06, 2.74) |
Lowc,e |
Small increase Parent-reported oral CS use from 2–6 years of age among infants born premature (32–35 wGA) with vs. without hospitalization for RSV at <12 months |
| Asthma medication (leukotriene antagonist) | |||||||||
| At-risk with RSV-H vs. at-risk without RSV-H | Prematurity: 32–35 wGA, RSV-H |
Prematurity: 32–35 wGA, No RSV-H |
Across 2–6 y | PC32 (n=1); 487 |
6 per 100 | 10 more per 100 (3–22 more) |
RR 2.52 (1.43, 4.42) |
Lowc,e |
Increased Parent-reported leukotriene antagonist use from 2–6 years of age among infants born premature (32–35 wGA) with vs. without hospitalization for RSV at <12 months |
Abbreviations: CI, confidence interval; CS, corticosteroid(s); FU, follow-up; ICS, inhaled corticosteroid(s); no., number; NS, not significant; OR, odds ratio; PC, prospective cohort; RR, risk ratio; RSV, respiratory syncytial virus; RSV-H, respiratory syncytial virus hospitalization; vs.: versus; wGA, weeks’ gestational age; y, year(s)
a Absolute risk reductions were calculated when findings were statistically significant; NS denotes when findings were not statistically significant
Certainty of evidence was assessed for each outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Starting at high for observational studies (for prognosis evidence) each outcome is rated as high, moderate, low or very low based on downgrading (if any) for one or more of the following domains:
b Study limitations, including selective outcome reporting
c Inconsistency
d Indirectness
e Imprecision
f Half decrement (-0.5) due to small concern for this domain