Lower Airway Rhinovirus Burden and the Seasonal Risk of Asthma Exacerbation

被引:80
作者
Denlinger, Loren C. [1 ]
Sorkness, Ron L. [2 ,4 ]
Lee, Wai-Ming [4 ]
Evans, Michael D. [3 ]
Wolff, Michele J.
Mathur, Sameer K. [5 ]
Crisafi, Gina M.
Gaworski, Katie L.
Pappas, Tressa E. [4 ]
Vrtis, Rose F.
Kelly, Elizabeth A.
Gern, James E. [4 ]
Jarjour, Nizar N.
机构
[1] Univ Wisconsin, Sch Med & Publ Hlth, Div Allergy Pulm & Crit Care Med, Dept Med Allergy Pulm & Crit Care, Madison, WI 53792 USA
[2] Univ Wisconsin, Dept Pharm, Madison, WI 53792 USA
[3] Univ Wisconsin, Dept Biostat & Med Informat, Madison, WI 53792 USA
[4] Univ Wisconsin, Dept Pediat Allergy & Immunol, Madison, WI 53792 USA
[5] William S Middleton VA Hosp, Madison, WI USA
基金
美国国家卫生研究院;
关键词
asthma; virus; exacerbation; index; neutrophil; RESPIRATORY-TRACT; COMMON COLD; HOSPITAL ADMISSION; 16; INFECTION; VIRUS; SEVERITY; RECEPTOR; INFLAMMATION; ADULTS; CELLS;
D O I
10.1164/rccm.201103-0585OC
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Rationale: Most asthma exacerbations are initiated by viral upper respiratory illnesses. It is unclear whether human rhinovirus (HRV)-induced exacerbations are associated with greater viral replication and neutrophilic inflammation compared with HRV colds. Objectives: To evaluate viral strain and load in a prospective asthma cohort during a natural cold. Methods: Adults were enrolled at the first sign of a cold, with daily monitoring of symptoms, medication use, and peak expiratory flow rate until resolution. Serial nasal lavage and induced sputum samples were assessed for viral copy number and inflammatory cell counts. Measurements and Main Results: A total of 52 persons with asthma and 14 control subjects without atopy or asthma were studied for over 10 weeks per subject on average; 25 participants developed an asthma exacerbation. Detection of HRVs in the preceding 5 days was the most common attributable exposure related to exacerbation. Compared with other infections, those by a minor group A HRV were 4.4-fold more likely to cause exacerbation (P = 0.038). Overall, sputum neutrophils and the burden of rhinovirus in the lower airway were similar in control subjects without atopy and the asthma group. However, among HRV-infected participants with asthma, exacerbations were associated with greater sputum neutrophil counts (P = 0.005). Conclusions: HRV infection is a frequent cause of exacerbations in adults with asthma and a cold, and there may be group-specific differences in severity of these events. The absence of large differences in viral burden among groups suggests differential lower airway sensitization to the effects of neutrophilic inflammation in the patients having exacerbations.
引用
收藏
页码:1007 / 1014
页数:8
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