Hospitalizations and outpatient visits for rhinovirus-associated acute respiratory illness in adults

Abstract

Background Rhinovirus is linked to asthma exacerbations and chronic obstructive pulmonary disease exacerbations in adults. The severity and rates of rhinovirus acute respiratory illnesses (ARI) in adults are uncertain. Objectives We determined rhinovirus-associated ARI rates in adults presenting for care in multiple settings and identified factors associated with rhinovirus detection. Methods This prospective, population-based cohort enrolled Tennessee residents ≥18 years old in the emergency department (ED), outpatient clinics, or hospitalized for ARI December 2008-May 2010. Nasal/throat swabs were collected and tested for rhinovirus and other viruses by RT-PCR. Rates of ED visits and hospitalizations were calculated and rhinovirus-positive and -negative patients were compared. Results Among 2351 enrollees, rhinovirus was detected in 247 (11%). There were 7 rhinovirus-associated ED visits and 3 hospitalizations per 1000 adults annually. Patients with rhinovirus, compared to virus-negative ARI, were more likely to present with wheezing (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.23-2.35, p<0.001), to be a current smoker (OR 2.31, CI 1.68-3.19) or live with a smoker (OR 1.72, CI 1.10-2.67), have a history of chronic respiratory disease (OR 1.61, CI 1.17-2.22), and were less likely to be hospitalized versus seen in the outpatient setting (OR 0.58, CI 0.41-0.83). Conclusion Rhinovirus is associated with a substantial number of ED visits and hospitalizations for ARI in adults. There may be modifiable factors that can reduce the likelihood of presenting with rhinovirus-associated ARI.

Presence of rhinovirus in the respiratory tract of adolescents and young adults with asthma without symptoms of infection

“…However, a slightly larger proportion of the asthmatic subjects were examined outside the common cold season, which may have reduced the chance of finding HRV in asthmatics relative to controls. Furthermore, the difference in HRV prevalence between the groups was seen in spite of the fact that a significantly larger proportion of control subjects than asthmatics were smokers, a factor that may increase susceptibility to HRV infections [23,24]. Accordingly, there was a trend towards higher prevalence of smokers in HRV þ asthmatics versus HRV À asthmatics in our study.…”

Immune Responses in Rhinovirus-Induced Asthma Exacerbations

“…RV infection can induce lower respiratory tract symptoms, including cough, shortness of breath, chest tightness, and wheezing in patients with underlying asthma or other chronic lung diseases [13•, 34–38]. As IgE levels rise, the severity of lower respiratory tract symptoms increases in the asthmatic group [30].…”

“…Rhinovirus (RV) accounts for 60–70 % of these virus-associated exacerbations in children over the age of 3 [5–12]. And, while a less frequent an occurrence, RV infections remain a common cause of asthma exacerbations throughout adulthood [13•]. In our studies at the University of Virginia, RV infections were identified in 61 % of children aged 3–18 years hospitalized with an asthma exacerbation [14] with similar numbers observed in a follow-up study that was performed in Costa Rica [15].…”

Pediatric Asthma and Viral Infection

“…1,2 Respiratory viruses are one of the most common causes of asthma exacerbations in both adults and children. [3][4][5][6] Furthermore, increasing evidence is emerging to suggest that viral respiratory infections in early life are related with the medium and long-term development of asthma. 7,8 This article aims first to review the role of viruses as precipitating factors for asthma, and then to summarize the current state of knowledge on their role in asthma exacerbations.…”