Based on data from around 700 individuals, preschoolers who had communicable cough in their infancy were significantly more likely to develop chronic respiratory conditions.
“Lower respiratory tract infections (LRTI) in the early years of life can cause damage to the lung’s rapidly developing at its most critical stage,” wrote Rotem Lapidot, MD, of Boston University, Massachusetts, and colleagues. The researchers said that although previous research has revealed a link between pneumonia and subsequent chronic cough, respiratory tract infections and recurrent pneumonia in children; however, data are required to determine the effects of early community-acquired CAP on the respiratory health of otherwise healthy infants.
In a retrospective matched cohort study published in Respiratory Medicine, the researchers identified 1343 infants with CAP within the first two years of life, as well as 6715 controls , using a massive electronic health records database (Optum EHR dataset) for the period from January 2011 through June 2018.
The most important outcomes were the emergence of chronic respiratory disorder, reactive airway disease, and CAP hospitalizations between the ages of 2 and 5 years. Infants in the CAP group were otherwise healthy, while those who had congenital or other ailments that could predispose them to pneumonia were not included. The baseline characteristics were similar between the CAP patients and the controls.
Future Risk
The rates per 100 years of patient for any chronic respiratory disorder were 11.6 for patients with CAP and 4.9 for controls (relative risc 2.4). Rates for reactive airway disease and hospitalization for CAP were 6.1 vs 1.9 per 100 patient-years (RR 3.2) and 1.0 vs 0.2 per 100 patient-years (RR 6.3) for patients with CAP and the controls, respectively.
The distribution of CAP etiology of CAP in infants during the first hospitalization was 20% bacterial, 27% viral and 53% unknown. Researchers found that the rates of later respiratory illnesses were similar for all etiologies of infant CAP hospitalizations. This confirms the connection between infant and later respiratory illnesses.
Nearly all (97%) of the CAP patients had only one qualifying hospitalization for CAP before 2 years of age and the mean age at the time of the first hospitalization was 8.9 months. Researchers observed that rates and relative rates for any chronic respiratory disorder as well as our composite for reactive lung disease increased with age. Children who were admitted to hospitals at or near 2 years old had the highest rates.
Persistent Inflammation?
“Our findings add to the growing theory that chronic inflammation after pneumonia creates an increased risk of developing respiratory conditions and exacerbations of the underlying disease,” researchers wrote in their paper.
Researchers noted that the study’s findings were hampered by a variety of factors which include the possibility of confusion between infants with and without conditions, reliance upon discharge data for etiology, and the possibility of not being generalizable to other population.
However, the results indicate an increased risk of respiratory illnesses in the early years among infants with CAP and confirm the need to pay more focus on CAP prevention and for strategies to reduce inflammation following pneumonia, they added. “Further research is needed to confirm the long-term consequences of infant CAP, as well as the mechanisms that contribute to these long-term repercussions,” they concluded.
The study was published Respiratory Medicine:Vol 19, 106671 January 1, 2022.
The study was financed by Pfizer. Pfizer provided financial support to Lapidot the principal author, and several of his coauthors. Many coauthors are employees of Pfizer.
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