Exploring the potential mediating role of systemic antibiotics in the association between early-life lower respiratory tract infections and asthma at age 5 in the CHILD study
ObjectiveLower respiratory tract infections (LRTIs) in early life are one of the strongest risk factors for childhood asthma and are often treated with systemic antibiotics (IV or oral). We aimed to explore the association between early-life LRTIs and systemic antibiotics on asthma development and t...
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Frontiers Media S.A.
2025-01-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/falgy.2024.1463867/full |
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| author | Maria V. Medeleanu Maria V. Medeleanu Myrtha E. Reyna Myrtha E. Reyna Darlene L. Y. Dai Geoffrey L. Winsor Fiona S. L. Brinkman Rahul Verma Ella Nugent Nashita Riaz Elinor Simons Piushkumar J. Mandhane Piushkumar J. Mandhane Meghan B. Azad Meghan B. Azad Stuart E. Turvey Stuart E. Turvey Theo J. Moraes Theo J. Moraes Padmaja Subbarao Padmaja Subbarao Padmaja Subbarao Padmaja Subbarao Padmaja Subbarao Padmaja Subbarao |
| author_facet | Maria V. Medeleanu Maria V. Medeleanu Myrtha E. Reyna Myrtha E. Reyna Darlene L. Y. Dai Geoffrey L. Winsor Fiona S. L. Brinkman Rahul Verma Ella Nugent Nashita Riaz Elinor Simons Piushkumar J. Mandhane Piushkumar J. Mandhane Meghan B. Azad Meghan B. Azad Stuart E. Turvey Stuart E. Turvey Theo J. Moraes Theo J. Moraes Padmaja Subbarao Padmaja Subbarao Padmaja Subbarao Padmaja Subbarao Padmaja Subbarao Padmaja Subbarao |
| author_sort | Maria V. Medeleanu |
| collection | DOAJ |
| description | ObjectiveLower respiratory tract infections (LRTIs) in early life are one of the strongest risk factors for childhood asthma and are often treated with systemic antibiotics (IV or oral). We aimed to explore the association between early-life LRTIs and systemic antibiotics on asthma development and the potential mediating role of antibiotics in this relationship.MethodsData were collected as part of the longitudinal, general Canadian population CHILD Study. LRTIs during the first 18 months of life were identified through parental symptom report at regular study visits. Systemic antibiotic use was defined as at least one dose of oral/intravenous antibiotics between birth and the 18-month visit and were further categorized by indication as either given for a respiratory indication (upper or lower respiratory symptoms) or non-respiratory indication. Asthma was diagnosed by in-study pediatricians at the 5-year study visit. Adjusted logistic regression models and mediation analyses via systemic antibiotics use were performed.ResultsAmong 2,073 participants included in our analysis, 72 (4.9%) had asthma age 5, and 609 (29.3%) used systemic antibiotics before the 18-month visit. Among children who had taken antibiotics, 61.6% also had an LRTI in that period compared to 49.7% among children without exposure to systemic antibiotics (p < .001). Moderate-severe LRTIs before age 18 months were associated with higher odds of 5-year asthma [aOR 4.12 (95%CI 2.04–7.95) p < .001]. Antibiotics taken for respiratory indications were associated with higher odds of asthma at age 5 [aOR 2.36 (95%CI 1.59–3.48) p < .001]. Children who received systemic antibiotics for only non-respiratory indications during the first 18 months of life were not associated with increased odds of asthma [aOR 1.08 (95%CI 0.44–2.30) p = .851]. Using mediation analysis, 21.7% of the association between LRTI and asthma is estimated to be mediated through use of early-life systemic antibiotics. However, a significant direct effect of moderate-to-severe LRTIs on asthma risk remained in adjusted mediation models (p = .014).ConclusionThrough mediation modeling we estimate that the increased risk of asthma at age 5 that is associated with moderate-severe LRTIs in infancy may be partially mediated by systemic antibiotics taken during the first 18 months of life. This underscores the importance of public health strategies focused on antibiotic stewardship and reducing early life LRTIs to mitigate asthma risk. |
| format | Article |
| id | doaj-art-c2c0170b24cf4be380eff85071a0bde2 |
| institution | Kabale University |
| issn | 2673-6101 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Allergy |
| spelling | doaj-art-c2c0170b24cf4be380eff85071a0bde22025-01-21T08:37:04ZengFrontiers Media S.A.Frontiers in Allergy2673-61012025-01-01510.3389/falgy.2024.14638671463867Exploring the potential mediating role of systemic antibiotics in the association between early-life lower respiratory tract infections and asthma at age 5 in the CHILD studyMaria V. Medeleanu0Maria V. Medeleanu1Myrtha E. Reyna2Myrtha E. Reyna3Darlene L. Y. Dai4Geoffrey L. Winsor5Fiona S. L. Brinkman6Rahul Verma7Ella Nugent8Nashita Riaz9Elinor Simons10Piushkumar J. Mandhane11Piushkumar J. Mandhane12Meghan B. Azad13Meghan B. Azad14Stuart E. Turvey15Stuart E. Turvey16Theo J. Moraes17Theo J. Moraes18Padmaja Subbarao19Padmaja Subbarao20Padmaja Subbarao21Padmaja Subbarao22Padmaja Subbarao23Padmaja Subbarao24Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, CanadaDepartment of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, CanadaTranslational Medicine Program, The Hospital for Sick Children, Toronto, ON, CanadaEpidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, CanadaDepartment of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, BC, CanadaDepartment of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, CanadaDepartment of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, CanadaDivision of Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, CanadaTranslational Medicine Program, The Hospital for Sick Children, Toronto, ON, CanadaTranslational Medicine Program, The Hospital for Sick Children, Toronto, ON, CanadaDepartment of Pediatrics and Child Health, Section of Allergy and Immunology, University of Manitoba, Winnipeg, MB, CanadaDepartment of Pediatrics, University of Alberta, Edmonton, AB, CanadaFaculty of Medicine & Health Sciences, UCSI University, Kuala Lampur, Malaysia0Manitoba Interdisciplinary Lactation Centre (MILC), Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada1Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, CanadaDepartment of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada1Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, CanadaTranslational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada2Division of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, CanadaTranslational Medicine Program, The Hospital for Sick Children, Toronto, ON, CanadaDepartment of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, CanadaEpidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada2Division of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada3Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada4Department of Medicine, McMaster University, Hamilton, ON, CanadaObjectiveLower respiratory tract infections (LRTIs) in early life are one of the strongest risk factors for childhood asthma and are often treated with systemic antibiotics (IV or oral). We aimed to explore the association between early-life LRTIs and systemic antibiotics on asthma development and the potential mediating role of antibiotics in this relationship.MethodsData were collected as part of the longitudinal, general Canadian population CHILD Study. LRTIs during the first 18 months of life were identified through parental symptom report at regular study visits. Systemic antibiotic use was defined as at least one dose of oral/intravenous antibiotics between birth and the 18-month visit and were further categorized by indication as either given for a respiratory indication (upper or lower respiratory symptoms) or non-respiratory indication. Asthma was diagnosed by in-study pediatricians at the 5-year study visit. Adjusted logistic regression models and mediation analyses via systemic antibiotics use were performed.ResultsAmong 2,073 participants included in our analysis, 72 (4.9%) had asthma age 5, and 609 (29.3%) used systemic antibiotics before the 18-month visit. Among children who had taken antibiotics, 61.6% also had an LRTI in that period compared to 49.7% among children without exposure to systemic antibiotics (p < .001). Moderate-severe LRTIs before age 18 months were associated with higher odds of 5-year asthma [aOR 4.12 (95%CI 2.04–7.95) p < .001]. Antibiotics taken for respiratory indications were associated with higher odds of asthma at age 5 [aOR 2.36 (95%CI 1.59–3.48) p < .001]. Children who received systemic antibiotics for only non-respiratory indications during the first 18 months of life were not associated with increased odds of asthma [aOR 1.08 (95%CI 0.44–2.30) p = .851]. Using mediation analysis, 21.7% of the association between LRTI and asthma is estimated to be mediated through use of early-life systemic antibiotics. However, a significant direct effect of moderate-to-severe LRTIs on asthma risk remained in adjusted mediation models (p = .014).ConclusionThrough mediation modeling we estimate that the increased risk of asthma at age 5 that is associated with moderate-severe LRTIs in infancy may be partially mediated by systemic antibiotics taken during the first 18 months of life. This underscores the importance of public health strategies focused on antibiotic stewardship and reducing early life LRTIs to mitigate asthma risk.https://www.frontiersin.org/articles/10.3389/falgy.2024.1463867/fullpreschool asthmarespiratory tract infectionsantibioticsmediation analysescohort studyclinical epidemiology |
| spellingShingle | Maria V. Medeleanu Maria V. Medeleanu Myrtha E. Reyna Myrtha E. Reyna Darlene L. Y. Dai Geoffrey L. Winsor Fiona S. L. Brinkman Rahul Verma Ella Nugent Nashita Riaz Elinor Simons Piushkumar J. Mandhane Piushkumar J. Mandhane Meghan B. Azad Meghan B. Azad Stuart E. Turvey Stuart E. Turvey Theo J. Moraes Theo J. Moraes Padmaja Subbarao Padmaja Subbarao Padmaja Subbarao Padmaja Subbarao Padmaja Subbarao Padmaja Subbarao Exploring the potential mediating role of systemic antibiotics in the association between early-life lower respiratory tract infections and asthma at age 5 in the CHILD study Frontiers in Allergy preschool asthma respiratory tract infections antibiotics mediation analyses cohort study clinical epidemiology |
| title | Exploring the potential mediating role of systemic antibiotics in the association between early-life lower respiratory tract infections and asthma at age 5 in the CHILD study |
| title_full | Exploring the potential mediating role of systemic antibiotics in the association between early-life lower respiratory tract infections and asthma at age 5 in the CHILD study |
| title_fullStr | Exploring the potential mediating role of systemic antibiotics in the association between early-life lower respiratory tract infections and asthma at age 5 in the CHILD study |
| title_full_unstemmed | Exploring the potential mediating role of systemic antibiotics in the association between early-life lower respiratory tract infections and asthma at age 5 in the CHILD study |
| title_short | Exploring the potential mediating role of systemic antibiotics in the association between early-life lower respiratory tract infections and asthma at age 5 in the CHILD study |
| title_sort | exploring the potential mediating role of systemic antibiotics in the association between early life lower respiratory tract infections and asthma at age 5 in the child study |
| topic | preschool asthma respiratory tract infections antibiotics mediation analyses cohort study clinical epidemiology |
| url | https://www.frontiersin.org/articles/10.3389/falgy.2024.1463867/full |
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