Association between rhinovirus wheezing illness and the development of childhood asthma: a meta-analysis

OBJECTIVE: The relation between early-life rhinovirus (RV) wheezing illness and later onset of wheezing/asthma remains a subject of debate. Therefore, we conducted this meta-analysis to evaluate the association between RV wheezing illness in the first 3 years of life and the subsequent development of wheezing/asthma. DESIGN: Systematic review and meta-analysis. METHODS: The PubMed, EMBASE, Web of Science, Chinese National Knowledge Infrastructure (CNKI) and Wanfang databases were systematically searched for studies published between 1988 and February 2017, and additional studies were found by searching reference lists of relevant articles. 2 reviewers independently extracted data and assessed the quality of each study. Results were pooled using fixed-effect models or random-effects models as appropriate. RESULTS: The meta-analysis included 15 original articles which met the criteria, while 10 articles reported the results of 4 longitudinal cohort studies with different follow-up periods. RV wheezing illness in the first 3 years of life was associated with an increased risk of wheezing/asthma in later life (relative risk (RR)=2.00, 95% CI 1.62 to 2.49, p<0.001). In subgroup analysis by age at follow-up, the association still remained significant in <10 years (RR=2.02, 95% CI 1.70 to 2.39, p<0.001) and ≥10 years (RR=1.92, 95% CI 1.36 to 2.72, p<0.001). CONCLUSIONS: The meta-analysis suggests an association between RV-induced wheezing in the first 3 years of life and the subsequent development of wheezing/asthma. Large-scale and well-designed studies that adequately address concerns for potential confounding factors are required to validate the risk identified in the current meta-analysis.