Incidence and clinical impact of respiratory viruses in adults with cystic fibrosis

被引:89
作者
Flight, William G. [1 ,2 ]
Bright-Thomas, Rowland J. [1 ,2 ]
Tilston, Peter [3 ]
Mutton, Kenneth J. [2 ,3 ]
Guiver, Malcolm [3 ]
Morris, Julie [1 ]
Webb, A. Kevin [1 ,2 ]
Jones, Andrew M. [1 ,2 ]
机构
[1] Univ Hosp South Manchester NHS Fdn Trust, Manchester M23 9LT, Lancs, England
[2] Univ Manchester, Inst Inflammat & Repair, Manchester, Lancs, England
[3] Cent Manchester Univ Hosp NHS Fdn Trust, Dept Virol, Manchester, Lancs, England
关键词
OBSTRUCTIVE PULMONARY-DISEASE; VIRAL-INFECTIONS; EXACERBATIONS; CHILDREN; DETERIORATION; RHINOVIRUSES; ILLNESSES; FREQUENCY; COMMUNITY; SYMPTOMS;
D O I
10.1136/thoraxjnl-2013-204000
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Background: Viral respiratory infection (VRI) is a common cause of pulmonary exacerbations in children with cystic fibrosis (CF). The importance of VRI in adult CF populations is unclear. Objective: To determine the incidence and clinical impact of VRI among adults with CF. Methods: One hundred adults with CF were followed up prospectively for 12 months. Sputum, nose swabs and throat swabs were collected every 2 months and at onset of pulmonary exacerbation. PCR assays for adenovirus, influenza A&B, human metapneumovirus, parainfluenza 1-3, respiratory syncytial virus and human rhinovirus were performed on each sample. Symptom scores, spirometry and inflammatory markers were measured at each visit. Results: One or more respiratory viruses were detected in 191/626 (30.5%) visits. Human rhinovirus accounted for 72.5% of viruses. Overall incidence of VRI was 1.66 (95% CI 1.39 to 1.92) cases/patient-year. VRI was associated with increased risk of pulmonary exacerbation (OR=2.19; 95% CI 1.56 to 3.08; p<0.001) and prescription of antibiotics (OR=2.26; 95% CI 1.63 to 3.13; p<0.001). Virus-positive visits were associated with higher respiratory symptom scores and greater C-reactive protein levels. Virus-positive exacerbations had a lower acute fall in FEV 1 than virus-negative exacerbations (12.7% vs 15.6%; p=0.040). The incidence of exacerbations, but not VRI, was associated with greater lung function decline over 12 months (-1.79% per pulmonary exacerbation/year; 95% CI -3.4 to -0.23; p=0.025). Conclusion: VRI is common in adults with CF and is associated with substantial morbidity. Respiratory viruses are a potential therapeutic target in CF lung disease.
引用
收藏
页码:247 / 253
页数:7
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