{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T15:07:31Z","timestamp":1779289651635,"version":"3.51.4"},"reference-count":30,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"unspecified","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Sino-U.S. CDC Cooperation Project","award":["No.1 NU2HJG000003-01-00"],"award-info":[{"award-number":["No.1 NU2HJG000003-01-00"]}]},{"name":"Shanghai Jiading District High-Quality Development Key Discipline of Infectious Disease Epidemiology","award":["GWGZLXK-2023-01"],"award-info":[{"award-number":["GWGZLXK-2023-01"]}]},{"name":"Shanghai Municipal Science and Technology Major Project","award":["ZD2021CY001"],"award-info":[{"award-number":["ZD2021CY001"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,5]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the impact of early-life human rhinovirus (HRV) and respiratory syncytial virus (RSV) infections on subsequent asthma development among children with acute respiratory infections (ARI), with a focus on the timing of infection during critical developmental windows.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Tertiary paediatric hospital\u2014Children\u2019s Hospital of Soochow University in eastern China\u2014with data linked to a regional health information system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 2628 children who were hospitalised with acute respiratory infections (ARI) and received respiratory virus testing between September 2017 and December 2024 were included in this study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was incident asthma. Associations between early-life HRV or RSV infection and asthma risk were evaluated using univariate and multivariable Cox proportional hazards models. Causal mediation analysis was applied to examine potential mediation by wheezing and bronchiolitis. Secondary outcomes were the frequency of asthma-related medical visits and number of exacerbations, analysed using multivariable negative binomial regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 616 (20.2%) children developed asthma. Cox regression showed that HRV-RSV (aHR=2.40, 95%\u2009CI 1.02 to 6.69) and s-HRV (aHR=1.56, 95%\u2009CI 1.10 to 2.22) were associated with asthma risk compared with negative controls, whereas s-RSV was not (aHR=1.31, 95%\u2009CI 0.89 to 1.89). Wheezing mediated 53.5% of the effect of HRV on asthma risk. Among asthma cases, both HRV and RSV were associated with increased asthma-related visits and exacerbations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Early-life hospitalisation for HRV or RSV, particularly at 13\u201324 months of age, may be associated with increased risk of asthma and greater asthma morbidity. These findings suggest a potential role of infection timing in shaping long-term respiratory outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-111954","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T14:10:38Z","timestamp":1779286238000},"page":"e111954","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Association of early-life human rhinovirus and respiratory syncytial virus infections with childhood asthma: a cohort study in Suzhou, China"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5262-8831","authenticated-orcid":false,"given":"Longsong","family":"Li","sequence":"first","affiliation":[{"name":"Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China"},{"name":"Fudan University School of Public Health, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaiyue","family":"Shen","sequence":"additional","affiliation":[{"name":"Fudan University School of Public Health, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qinghui","family":"Chen","sequence":"additional","affiliation":[{"name":"Soochow University Affiliated Children\u2019s Hospital, Suzhou, Jiangsu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liling","family":"Chen","sequence":"additional","affiliation":[{"name":"Suzhou Center for Disease Prevention and Control, Suzhou, Jiangsu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youyi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Fudan University School of Public Health, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ran","family":"Peng","sequence":"additional","affiliation":[{"name":"Fudan University School of Public Health, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianmei","family":"Tian","sequence":"additional","affiliation":[{"name":"Soochow University Affiliated Children\u2019s Hospital, Suzhou, Jiangsu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Genming","family":"Zhao","sequence":"additional","affiliation":[{"name":"Fudan University School of Public Health, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China"},{"name":"Fudan University School of Public Health, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"2026052007101834000_16.5.e111954.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)01450-1"},{"key":"2026052007101834000_16.5.e111954.2","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.12.04052","article-title":"Global, regional, and national prevalence of asthma in 2019: a systematic analysis and modelling study","volume":"12","author":"Song","year":"2022","journal-title":"J Glob Health"},{"key":"2026052007101834000_16.5.e111954.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-024-20330-1","article-title":"The epidemiology of asthma in Mainland China: a systematic review and meta-analysis","volume":"24","author":"Yu","year":"2024","journal-title":"BMC Public Health"},{"key":"2026052007101834000_16.5.e111954.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12931-025-03135-7","article-title":"Long-term trends in the burden of asthma in China: a joinpoint regression and age-period-cohort analysis based on the GBD 2021","volume":"26","author":"Li","year":"2025","journal-title":"Respir Res"},{"key":"2026052007101834000_16.5.e111954.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2021.10.001"},{"key":"2026052007101834000_16.5.e111954.6","doi-asserted-by":"crossref","DOI":"10.1002\/jmv.29876","article-title":"Viral respiratory infections requiring hospitalization in early childhood related to subsequent asthma onset and exacerbation risks","volume":"96","author":"Ha","year":"2024","journal-title":"J Med Virol"},{"key":"2026052007101834000_16.5.e111954.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2015.02.024"},{"key":"2026052007101834000_16.5.e111954.8","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1097\/INF.0000000000002178","article-title":"Influenza-associated Hospitalization in Children Younger Than 5 Years of Age in Suzhou, China, 2011-2016","volume":"38","author":"Yu","year":"2019","journal-title":"Pediatr Infect Dis J"},{"key":"2026052007101834000_16.5.e111954.9","first-page":"335","article-title":"Study on viral etiology of hospitalized children with acute respiratory infection in Suzhou","volume":"22","author":"Shan","year":"2018","journal-title":"Chin J Dis Control Prev"},{"key":"2026052007101834000_16.5.e111954.10","first-page":"208","article-title":"Guidelines for the prevention and management of bronchial asthma (2024 edition)","volume":"48","year":"2025","journal-title":"Zhonghua Jie He He Hu Xi Za Zhi"},{"key":"2026052007101834000_16.5.e111954.11","doi-asserted-by":"crossref","first-page":"1878","DOI":"10.1111\/all.16611","article-title":"The Impact of Rhinovirus, Syncytial Respiratory Virus and Helminth Infection on the Risk of New-Onset Asthma and Other Allergic Conditions-A Systematic Review for the EAACI Guidelines on Environmental Science for Allergic Diseases and Asthma","volume":"80","author":"Agache","year":"2025","journal-title":"Allergy"},{"key":"2026052007101834000_16.5.e111954.12","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1007\/s12519-021-00436-x","article-title":"Increasing prevalence and influencing factors of childhood asthma: a cross-sectional study in Shanghai, China","volume":"17","author":"Hu","year":"2021","journal-title":"World J Pediatr"},{"key":"2026052007101834000_16.5.e111954.13","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.10.010801","article-title":"The disease burden of childhood asthma in China: a systematic review and meta-analysis","volume":"10","author":"Li","year":"2020","journal-title":"J Glob Health"},{"key":"2026052007101834000_16.5.e111954.14","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1016\/j.jaci.2016.12.991","article-title":"Rhinovirus-induced first wheezing episode predicts atopic but not nonatopic asthma at school age","volume":"140","author":"Lukkarinen","year":"2017","journal-title":"J Allergy Clin Immunol"},{"key":"2026052007101834000_16.5.e111954.15","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1111\/apa.12720","article-title":"Recurrent wheezing 36 months after bronchiolitis is associated with rhinovirus infections and blood eosinophilia","volume":"103","author":"Midulla","year":"2014","journal-title":"Acta Paediatr"},{"key":"2026052007101834000_16.5.e111954.16","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1097\/INF.0000000000001017","article-title":"Post-bronchiolitis Use of Asthma Medication: A Prospective 1-year Follow-up Study","volume":"35","author":"Bergroth","year":"2016","journal-title":"Pediatr Infect Dis J"},{"key":"2026052007101834000_16.5.e111954.17","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.jaci.2016.03.049","article-title":"Early life rhinovirus wheezing, allergic sensitization, and asthma risk at adolescence","volume":"139","author":"Rubner","year":"2017","journal-title":"J Allergy Clin Immunol"},{"key":"2026052007101834000_16.5.e111954.18","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200802-309OC"},{"key":"2026052007101834000_16.5.e111954.19","doi-asserted-by":"crossref","DOI":"10.1111\/pai.14067","article-title":"Genetics of preschool wheeze and its progression to childhood asthma","volume":"35","author":"Wolters","year":"2024","journal-title":"Pediatr Allergy Immunol"},{"key":"2026052007101834000_16.5.e111954.20","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/j.jaip.2022.01.006","article-title":"Rhinovirus Infections and Their Roles in Asthma: Etiology and Exacerbations","volume":"10","author":"Jackson","year":"2022","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2026052007101834000_16.5.e111954.21","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2022.1017325","article-title":"Respiratory virus type to guide predictive enrichment approaches in the management of the first episode of bronchiolitis: A systematic review","volume":"13","author":"Ambro\u017cej","year":"2022","journal-title":"Front Immunol"},{"key":"2026052007101834000_16.5.e111954.22","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202312-2249SO"},{"key":"2026052007101834000_16.5.e111954.23","doi-asserted-by":"crossref","DOI":"10.1111\/pai.13741","article-title":"The role of respiratory syncytial virus- and rhinovirus-induced bronchiolitis in recurrent wheeze and asthma-A systematic review and meta-analysis","volume":"33","author":"Makrinioti","year":"2022","journal-title":"Pediatr Allergy Immunol"},{"key":"2026052007101834000_16.5.e111954.24","doi-asserted-by":"crossref","first-page":"3428","DOI":"10.1002\/ppul.26667","article-title":"Association of rhinovirus and potentially pathogenic bacterial detections in the first 3 months of life with subsequent wheezing in childhood","volume":"58","author":"Takashima","year":"2023","journal-title":"Pediatr Pulmonol"},{"key":"2026052007101834000_16.5.e111954.25","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1002\/jmv.25037","article-title":"RSV-hRV co-infection is a risk factor for recurrent bronchial obstruction and early sensitization 3 years after bronchiolitis","volume":"90","author":"Amat","year":"2018","journal-title":"J Med Virol"},{"key":"2026052007101834000_16.5.e111954.26","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-2216"},{"key":"2026052007101834000_16.5.e111954.27","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00203511"},{"key":"2026052007101834000_16.5.e111954.28","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01196-2014"},{"key":"2026052007101834000_16.5.e111954.29","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2305478"},{"key":"2026052007101834000_16.5.e111954.30","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/S2352-4642(25)00093-8","article-title":"Real-world effectiveness of nirsevimab against respiratory syncytial virus disease in infants: a systematic review and meta-analysis","volume":"9","author":"Sumsuzzman","year":"2025","journal-title":"Lancet Child Adolesc Health"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-111954","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T14:10:43Z","timestamp":1779286243000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-111954"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":30,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,20]]},"published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1136\/bmjopen-2025-111954"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-111954","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}