Original Article
Symptomatic Viral Infection is Associated with Impaired Response to Treatment in Children with Acute Asthma

https://doi.org/10.1016/j.jpeds.2011.06.025Get rights and content

Objective

To examine the influence of viral respiratory infection (VRI) on treatment response in acute asthma in children.

Study design

A total of 218 children (mean age, 6.6 years) with acute asthma were recruited. Symptoms were recorded, an asthma severity score was determined, and whenever possible, a per-nasal aspirate was obtained for detection of viruses. Each child’s response to inhaled β2-agonists was assessed after 6, 12, and 24 hours.

Results

The 168 children with VRI symptoms received more treatment with inhaled β2-agonists after 6 hours (P = .010), 12 hours (P = .002), and 24 hours (P = .0005) compared with the 50 children without such symptoms. Asthma severity did not differ between the 2 groups. A per-nasal aspirate was obtained from 77% of the children. The most frequently identified virus was rhinovirus (61.4%). Among children with symptoms of a VRI, those with rhinovirus had an impaired response to β2-agonists at 6 hours (P = .032).

Conclusion

Children with acute asthma and symptoms of VRI respond less effectively to β2-agonists after 6, 12, or 24 hours and thus may benefit from more intense therapy and monitoring.

Section snippets

Methods

The study was designed as a prospective observational study and was approved by the Ethics Committee at Princess Margaret Hospital for Children, Perth, Australia. Patients with an acute asthma exacerbation were recruited after presentation at the hospital’s Emergency Department (ED), as described previously.8 Before participation, parental written informed consent was obtained for each child.

Patients with any other underlying chronic lung condition were excluded from the analysis. Based on

Results

A total of 218 children (mean age, 6.6 ± 3.5 years; 138 males) with an acute asthma attack were recruited. Of these 218 children, 168 had VRI symptoms. The children’s mean SaO2 was 93.7% ± 3.4%, and mean asthma severity score was 9.9 ± 2.3.

Discussion

This study demonstrates that the response to β2-agonists in children with acute asthma depends on the presence of clinical symptoms of VRI. Among children presenting with acute asthma to our ED, those with VRI symptoms required higher doses of salbutamol compared with those without these symptoms. This finding was independent of attack severity, given that SaO2 and acute asthma severity score were not influenced by VRI symptoms. Moreover, in children in whom a virus was isolated, RV had a

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    Supported by grants from the National Health and Medical Research Council of Australia, Asthma Foundation of Western Australia, and West Australian Institute of Medical Research. The authors declare no conflicts of interest.

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