BACKGROUND Lower respiratory tract infection (LRTI) caused by respiratory syncytial virus (RSV) has been associated with greater risk of recurrent wheezing and subsequent asthma. However, it is still unclear whether this association is causal or not. RSV-specific monoclonal antibodies have been shown to reduce RSV-related hospitalisations in high-risk infants, i.e. those born pre-term, but the longer term follow-up has given conflicting evidence for the prevention of recurrent wheeze or asthma. OBJECTIVE We aim to perform a systematic review and meta-analysis to determine whether or not prophylaxis with a monoclonal antibody for prevention of RSV-bronchiolitis reduces the risk of subsequent recurrent wheeze or asthma. If so, this would support the hypothesis that the association between RSV and recurrent wheeze and/or asthma is causative. METHODS To identify relevant studies, we will search a number of databases including Medline, Embase, PubMed and Web of Science and will also manually look for unpublished data by contacting the manufacturers of monoclonal antibodies. The intervention being investigated is RSV-specific monoclonal antibody prophylaxis, and the outcome being measured is recurrent wheeze and/or asthma. Studies will be screened according to inclusion/exclusion criteria, to include primary studies of any study design type. Eligible studies will then be evaluated for quality and assessed for bias independently by three reviewers using the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) approach. The results of the studies will be extracted into 2 × 2 outcome tables, and a meta-analysis will be carried out to produce forest plots based on relative risk. Heterogeneity will be assessed using the I2 statistic. The statistical software we will use is StatsDirect. DISCUSSION This review will aid in determining if the relationship between RSV and asthma development is a causal one, by showing the effect (if any) of RSV prophylaxis on subsequent recurrent wheeze/asthma. If this study shows RSV prophylaxis to have no effect on the outcome of recurrent wheeze/asthma, the question of causality remains.

中文翻译：

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用于预防复发性儿童喘息和哮喘的呼吸道合胞病毒预防：系统评价方案。


背景由呼吸道合胞病毒（RSV）引起的下呼吸道感染（LRTI）与反复喘息和随后的哮喘的更大风险相关。然而，目前尚不清楚这种关联是否存在因果关系。 RSV 特异性单克隆抗体已被证明可以减少高危婴儿（即早产婴儿）与 RSV 相关的住院治疗，但长期随访对于预防复发性喘息或哮喘给出了相互矛盾的证据。目的 我们的目的是进行系统评价和荟萃分析，以确定使用单克隆抗体预防 RSV 细支气管炎是否可以降低随后复发性喘息或哮喘的风险。如果是这样，这将支持 RSV 与复发性喘息和/或哮喘之间存在因果关系的假设。方法 为了确定相关研究，我们将检索包括 Medline、Embase、PubMed 和 Web of Science 在内的多个数据库，还将通过联系单克隆抗体制造商手动查找未发表的数据。正在研究的干预措施是 RSV 特异性单克隆抗体预防，正在测量的结果是复发性喘息和/或哮喘。将根据纳入/排除标准对研究进行筛选，包括任何研究设计类型的初步研究。然后，合格的研究将由三名评审员使用“建议评估、制定和评估分级”(GRADE) 方法独立评估质量和偏倚。研究结果将被提取到 2 × 2 结果表中，并进行荟萃分析以根据相对风险生成森林图。将使用 I2 统计量评估异质性。 我们将使用的统计软件是StatsDirect。讨论 本综述将通过显示 RSV 预防对随后复发性喘息/哮喘的影响（如果有），帮助确定 RSV 与哮喘发展之间是否存在因果关系。如果这项研究表明 RSV 预防对复发性喘息/哮喘的结果没有影响，那么因果关系问题仍然存在。