Risk Factors for Respiratory Syncytial Virus Illness Among Patients with Chronic Obstructive Pulmonary Disease

Abstract

Respiratory syncytial virus (RSV), although not typically considered an important pathogen in adults, may cause acute exacerbation of chronic obstructive pulmonary disease (COPD). It is unclear which COPD patients are at highest risk for developing serious RSV illness. Our objective was to identify risk factors for RSV illness among adult patients with COPD. We conducted a pooled analysis of data from COPD patients in 2 previously published longitudinal studies that examined RSV infection in high risk adults for ≤ 2 RSV seasons. Risk factors for RSV illness studied included age, sex, race, smoking status, exposure to children, home oxygen use, inhaled or oral steroid use, instrumental activities of daily living scores, and co-morbid conditions. Outcomes studied included symptomatic and medically attended RSV illness. Logistic regression was used to identify significant risk factors for RSV illness among older adults with COPD. Among 379 patients with COPD, the rate of symptomatic RSV illness was 11.1% (42/379); almost half (20/42) of whom required medical attention. In multivariable analyses, congestive heart failure (odds ratio [OR] = 4.18; 95% CI: 1.38, 12.69) and exposure to children (OR = 2.38; 95% CI: 1.03, 5.51) were risk factors for symptomatic RSV illness. Congestive heart failure (OR = 4.16; 95% CI: 1.02, 17.01) was the only significant risk factor for developing medically attended RSV illness. Exposure to children and congestive heart failure are risk factors for RSV illness among adult patients with COPD. Future prospective, well-designed studies are needed to corroborate these findings and examine other risk factors, including history of exacerbations.

Respiratory syncytial virus–associated illness in adults with advanced chronic obstructive pulmonary disease and/or congestive heart failure

“…The severity of adult RSV disease is likely multifactorial involving age, immune factors, and comorbid conditions . The presence of underlying COPD and CHF have been clearly defined as risk factors for severe illness and hospitalizations in prior studies . However, in our population of adults with Class III/IV COPD and CHF, it was surprising that illnesses were not as severe as expected.…”

Clinical characteristics and outcome of respiratory syncytial virus infection among adults hospitalized with influenza-like illness in France

“…Over the past decade, respiratory syncytial virus (RSV) has been increasingly recognized as an important pathogen in adults [1], and especially the elderly [2e4], immunocompromised patients [5,6] and individuals with underlying chronic respiratory diseases [7,8].…”

Respiratory Syncytial Virus Infections Enhance Cigarette Smoke Induced COPD in Mice

“…Once infected, RSV can persist in the lungs of COPD patients by antagonizing antiviral cytokines, mimicking chemokines, escaping detection through antigenic drift and by entering immune-privileged cells such as pulmonary neurons [17]. Though cigarette smoke impairs antiviral responses that clear RSV [18], [19], the consequence of persistent RSV infection on key disease parameters and outcomes in COPD has yet to be determined and larger clinical studies are need to identify if smoke exposure is a risk factor for increased RSV infections in COPD patients [20].…”