Association of early-life human rhinovirus and respiratory syncytial virus infections with childhood asthma: a cohort study in Suzhou, China

Objectives 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. Design Retrospective cohort study. Setting Tertiary paediatric hospital—Children’s Hospital of Soochow University in eastern China—with data linked to a regional health information system. Participants 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. Primary and secondary outcome measures 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. Results Overall, 616 (20.2%) children developed asthma. Cox regression showed that HRV-RSV (aHR=2.40, 95% CI 1.02 to 6.69) and s-HRV (aHR=1.56, 95% CI 1.10 to 2.22) were associated with asthma risk compared with negative controls, whereas s-RSV was not (aHR=1.31, 95% CI 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. Conclusions Early-life hospitalisation for HRV or RSV, particularly at 13–24 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.