ORCID ID
Graduation Date
Summer 8-14-2026
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Programs
Medical Sciences Interdepartmental Area
First Advisor
Russel McCulloh, M.D
Second Advisor
Jane Meza, Ph.D.
Third Advisor
John J. Lowe, Ph.D.
Fourth Advisor
Lani Zimmerman, Ph.D
Abstract
Bronchiolitis is a leading cause of infant hospitalization worldwide and is associated with substantial acute healthcare utilization and long-term respiratory morbidity. Although current management strategies emphasize supportive care, emerging evidence suggests that bronchiolitis represents a heterogeneous syndrome composed of clinically and biologically distinct phenotypes with differing inflammatory pathways and respiratory outcomes. In particular, wheezing-predominant bronchiolitis phenotypes characterized by atopic features and non-respiratory syncytial virus (RSV) infections have been associated with increased risk for recurrent wheezing and asthma development. However, important gaps remain in understanding the clinical characteristics, treatment patterns, and molecular airway signatures associated with these high-risk phenotypes.
This dissertation investigates the clinical and molecular heterogeneity of bronchiolitis with a specific focus on Profile A bronchiolitis, a wheezing-predominant phenotype associated with increased asthma risk. Chapter 1 characterizes the clinical features, management practices, and respiratory outcomes of infants hospitalized with Profile A bronchiolitis. Chapter 2 synthesizes the existing literature on nasopharyngeal protein and multi-omic signatures associated with bronchiolitis severity and long-term respiratory outcomes through a scoping review. Chapter 3 characterizes nasopharyngeal proteomic signatures among infants hospitalized with bronchiolitis to investigate molecular pathways associated with clinically relevant bronchiolitis phenotypes and future respiratory risk.
Collectively, these studies support the concept that bronchiolitis is not a uniform disease entity but instead encompasses heterogeneous airway inflammatory phenotypes associated with differing respiratory trajectories. Findings from this dissertation demonstrate that clinically identifiable Profile A bronchiolitis is associated with substantial long-term respiratory morbidity and suggest that this phenotype may represent an early manifestation of an asthma-prone airway disease process. Furthermore, the emerging body of nasopharyngeal proteomic and multi-omic literature, together with the findings of Chapter 3, suggests that clinically recognized Profile A bronchiolitis represents one manifestation of a broader asthma-prone airway phenotype among infants hospitalized with non-RSV bronchiolitis, extending beyond those who currently meet established clinical phenotype definitions. Integration of clinical phenotyping with nasopharyngeal molecular profiling may ultimately improve identification of infants at highest risk for persistent respiratory disease and provide a framework for future precision-medicine approaches and phenotype-specific therapeutic investigations in bronchiolitis.
Rights
The author holds the copyright to this work and any reuse or permissions must be obtained from the author directly.
Recommended Citation
Neemann, Kari, "Toward Precision Medicine in Bronchiolitis: Clinical Phenotypes, Airway Inflammation, and Nasopharyngeal Proteomic Signatures" (2026). Theses & Dissertations. 1094.
https://digitalcommons.unmc.edu/etd/1094