Community study of role of viral infections in exacerbations of asthma in 9-11 year old children

BMJ 1995;310:1225-1229 (13 May)

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Community study of role of viral infections in exacerbations of asthma in 9-11 year old children

Sebastian L Johnston, lecturer in medicine,^a Philip K Pattemore, senior lecturer in paediatrics,^a Gwendolyn Sanderson, research assistant,^a Sandra Smith, research nurse,^a Fiona Lampe, medical statistician,^b Lynn Josephs, research fellow,^a Penny Symington, research fellow,^a Susan O'Toole, research nurse,^a Steven H Myint, senior lecturer,^c David A J Tyrrell, director,^d Stephen T Holgate, professor of immunopharmacology ^a

^a University Medicine, Southampton General Hospital, Southampton SO9 4XY, ^b Department of Medical Statistics and Computing, University of Southampton, Southampton SO9 4XY, ^c Department of Microbiology, University of Leicester, Leicester LE1 9HN, ^d MRC Common Cold Unit, Salisbury

Correspondence to: Dr Johnston.

Abstract

Objective: To study the association between upper and lowerrespiratory viral infections and acute exacerbations of asthmain schoolchildren in the community.
Design: Community based 13 month longitudinal study using diarycard respiratory symptom and peak expiratory flow monitoringto allow early sampling for viruses.
Subjects: 108 Children aged 9-11 years who had reported wheezeor cough, or both, in a questionnaire.
Setting: Southampton and surrounding community.
Main outcome measures: Upper and lower respiratory viral infectionsdetected by polymerase chain reaction or conventional methods,reported exacerbations of asthma, computer identified episodesof respiratory tract symptoms or peak flow reductions.
Results: Viruses were detected in 80% of reported episodes ofreduced peak expiratory flow, 80% of reported episodes of wheeze,and in 85% of reported episodes of upper respiratory symptoms,cough, wheeze, and a fall in peak expiratory flow. The medianduration of reported falls in peak expiratory flow was 14 days,and the median maximum fall in peak expiratory flow was 81 1/min.The most commonly identified virus type was rhinovirus.
Conclusions: This study supports the hypothesis that upper respiratoryviral infections are associated with 80-85% of asthma exacerbationsin school age children.

Key messages

Key messages
In this study common cold viruses were found in 80-85% of reported exacerbations of asthma in children
Rhinoviruses, which cause most common colds, accounted for two thirds of viruses detected
Analysis of diary cards also showed large numbers of similar but less severe episodes that may also be viral in origin

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Hayden, F. G., Turner, R. B., Gwaltney, J. M., Chi-Burris, K., Gersten, M., Hsyu, P., Patick, A. K., Smith, G. J. III, Zalman, L. S. (2003). Phase II, Randomized, Double-Blind, Placebo-Controlled Studies of Ruprintrivir Nasal Spray 2-Percent Suspension for Prevention and Treatment of Experimentally Induced Rhinovirus Colds in Healthy Volunteers. Antimicrob. Agents Chemother. 47: 3907-3916 [Abstract] [Full text]
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de Kluijver, J., Evertse, C. E., Sont, J. K., Schrumpf, J. A., van Zeijl-van der Ham, C. J. G., Dick, C. R., Rabe, K. F., Hiemstra, P. S., Sterk, P. J. (2003). Are Rhinovirus-induced Airway Responses in Asthma Aggravated by Chronic Allergen Exposure?. Am. J. Respir. Crit. Care Med. 168: 1174-1180 [Abstract] [Full text]
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Tuthill, T. J., Papadopoulos, N. G., Jourdan, P., Challinor, L. J., Sharp, N. A., Plumpton, C., Shah, K., Barnard, S., Dash, L., Burnet, J., Killington, R. A., Rowlands, D. J., Clarke, N. J., Blair, E. D., Johnston, S. L. (2003). Mouse respiratory epithelial cells support efficient replication of human rhinovirus. J. Gen. Virol. 84: 2829-2836 [Abstract] [Full text]