Original ArticleSymptomatic Viral Infection is Associated with Impaired Response to Treatment in Children with Acute Asthma
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
References (29)
- et al.
An international observational prospective study to determine the cost of asthma exacerbations (COAX)
Respir Med
(2006) - et al.
Frequency, severity, and duration of rhinovirus infections in asthmatic and non-asthmatic individuals: a longitudinal cohort study
Lancet
(2002) - et al.
Evaluation of nested polymerase chain methods for the detection of human coronaviruses 229E and OC43
Mol Cell Probes
(1994) - et al.
Efficacy of a short course of parent-initiated oral prednisolone for viral wheeze in children aged 1-5 years: randomised controlled trial
Lancet
(2003) - et al.
How viral infections cause exacerbation of airway diseases
Chest
(2006) - et al.
Viral infections in relation to age, atopy, and season of admission among children hospitalized for wheezing
J Allergy Clin Immunol
(2004) - et al.
Multiplex molecular detection of respiratory pathogens in children with asthma exacerbation
Chest
(2010) - et al.
The role of rhinovirus in asthma exacerbations
J Allergy Clin Immunol
(2005) - et al.
Mechanisms of rhinovirus-induced asthma
Paediatr Respir Rev
(2004) - et al.
Epidemiology, clinical and economic burden, and natural history of chronic obstructive pulmonary disease and asthma
Am J Manag Care
(2004)
Community study of role of viral infections in exacerbations of asthma in 9- to 11-year-old children
BMJ
Role of viral infections, atopy and antiviral immunity in the etiology of wheezing exacerbations among children and young adults
Pediatr Infect Dis J
Study of modifiable risk factors for asthma exacerbations: virus infection and allergen exposure increase the risk of asthma hospital admissions in children
Thorax
Mechanisms of virus-induced asthma exacerbations: state of the art. A GA2LEN and InterAirways document
Allergy
Cited by (18)
β2-Adrenoceptor Function in Asthma
2017, Advances in ImmunologyCitation Excerpt :Adult asthmatic patients experiencing virally induced exacerbations have a reduced bronchodilator response to β2-agonists (Reddel et al., 1999). Similarly, asthmatic children presenting for acute asthma associated with symptoms of respiratory infection required more treatment with β2-agonists compared to children without any virus infection (Rueter et al., 2012). Whether respiratory viruses including rhinovirus (RV) directly interfere with the bronchoprotective of β2-agonists has been suggested by multiple experimental studies.
Molecular epidemiology of human rhinovirus infections in the pediatric emergency department
2015, Journal of Clinical VirologyCitation Excerpt :HRV has been historically considered to be a minor pathogen, but with the development of sensitive molecular diagnostics, the virus has been increasingly associated with severe respiratory disease, particularly in children [4,5]. In hospital and community settings, HRV has been linked to lower respiratory tract illness (LRTI), wheezing, acute asthma, and death in children [6–9]. HRVs are phylogenetically classified into three species: HRV-A, HRV-B, and the recently discovered HRV-C. All three species have been associated with acute respiratory illness.
Exacerbation of asthma and airway infection: Is the virus the villain?
2014, Jornal de PediatriaCitation Excerpt :Children with viral symptoms had poor response to bronchodilators, requiring more doses of beta-agonists after 6, 12, and 24 hours. The viral screening was conducted in 77.0% of cases; hRV was the most frequently found virus (61.4%).33 In another study, 78 exacerbated children were treated at the hospital and compared to 78 asymptomatic adults.
Patient characteristics and severity of human rhinovirus infections in children
2013, Journal of Clinical VirologyCitation Excerpt :They have been most frequently implicated as the causative agent of common cold. However, there were recent suggestions that HRV could be associated with severe respiratory tract infections (RTI), acute asthma exacerbations [1,2], recurring wheeze [3] and lower RTI (LRTI) [4–7]. Dependent on the study, the reported incidence of HRV infections in children ranges from <10% in RTI [8] to 90% in acute asthma [9].
Remember the Airway Smooth Muscle! How Rhinovirus Impairs Bronchodilator Responses
2023, American Journal of Respiratory Cell and Molecular BiologyDeterminants of cough and caregivers' quality of life in pediatric asthma exacerbations
2021, Pediatric Pulmonology
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.