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Lower airway rhinovirus burden and the seasonal risk of asthma exacerbation.
Am J Respir Crit Care Med 2011; 184(9):1007-14AJ

Abstract

RATIONALE

Most asthma exacerbations are initiated by viral upper respiratory illnesses. It is unclear whether human rhinovirus (HRV)–induced exacerbations are associated with greater viral replication and neutrophilic inflammation compared with HRV colds.

OBJECTIVES

To evaluate viral strain and load in a prospective asthma cohort during a natural cold.

METHODS

Adults were enrolled at the first sign of a cold, with daily monitoring of symptoms, medication use, and peak expiratory flow rate until resolution. Serial nasal lavage and induced sputum samples were assessed for viral copy number and inflammatory cell counts.

MEASUREMENTS AND MAIN RESULTS

A total of 52 persons with asthma and 14 control subjects without atopy or asthma were studied for over 10 weeks per subject on average; 25 participants developed an asthma exacerbation. Detection of HRVs in the preceding 5 days was the most common attributable exposure related to exacerbation. Compared with other infections, those by a minor group A HRV were 4.4- fold more likely to cause exacerbation (P = 0.038). Overall, sputum neutrophils and the burden of rhinovirus in the lower airway were similar in control subjects without atopy and the asthma group. However, among HRV-infected participants with asthma, exacerbations were associated with greater sputum neutrophil counts (P = 0.005).

CONCLUSIONS

HRV infection is a frequent cause of exacerbations in adults with asthma and a cold, and there may be group-specific differences in severity of these events. The absence of large differences in viral burden among groups suggests differential lower airway sensitization to the effects of neutrophilic inflammation in the patients having exacerbations.

Authors+Show Affiliations

Department of Medicine-Allergy, Pulmonary & Critical Care, University of Wisconsin-Madison, 53792, USA. lcd@medicine.wisc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

21816938

Citation

Denlinger, Loren C., et al. "Lower Airway Rhinovirus Burden and the Seasonal Risk of Asthma Exacerbation." American Journal of Respiratory and Critical Care Medicine, vol. 184, no. 9, 2011, pp. 1007-14.
Denlinger LC, Sorkness RL, Lee WM, et al. Lower airway rhinovirus burden and the seasonal risk of asthma exacerbation. Am J Respir Crit Care Med. 2011;184(9):1007-14.
Denlinger, L. C., Sorkness, R. L., Lee, W. M., Evans, M. D., Wolff, M. J., Mathur, S. K., ... Jarjour, N. N. (2011). Lower airway rhinovirus burden and the seasonal risk of asthma exacerbation. American Journal of Respiratory and Critical Care Medicine, 184(9), pp. 1007-14. doi:10.1164/rccm.201103-0585OC.
Denlinger LC, et al. Lower Airway Rhinovirus Burden and the Seasonal Risk of Asthma Exacerbation. Am J Respir Crit Care Med. 2011 Nov 1;184(9):1007-14. PubMed PMID: 21816938.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lower airway rhinovirus burden and the seasonal risk of asthma exacerbation. AU - Denlinger,Loren C, AU - Sorkness,Ron L, AU - Lee,Wai-Ming, AU - Evans,Michael D, AU - Wolff,Michele J, AU - Mathur,Sameer K, AU - Crisafi,Gina M, AU - Gaworski,Katie L, AU - Pappas,Tressa E, AU - Vrtis,Rose F, AU - Kelly,Elizabeth A, AU - Gern,James E, AU - Jarjour,Nizar N, PY - 2011/8/6/entrez PY - 2011/8/6/pubmed PY - 2012/1/28/medline SP - 1007 EP - 14 JF - American journal of respiratory and critical care medicine JO - Am. J. Respir. Crit. Care Med. VL - 184 IS - 9 N2 - RATIONALE: Most asthma exacerbations are initiated by viral upper respiratory illnesses. It is unclear whether human rhinovirus (HRV)–induced exacerbations are associated with greater viral replication and neutrophilic inflammation compared with HRV colds. OBJECTIVES: To evaluate viral strain and load in a prospective asthma cohort during a natural cold. METHODS: Adults were enrolled at the first sign of a cold, with daily monitoring of symptoms, medication use, and peak expiratory flow rate until resolution. Serial nasal lavage and induced sputum samples were assessed for viral copy number and inflammatory cell counts. MEASUREMENTS AND MAIN RESULTS: A total of 52 persons with asthma and 14 control subjects without atopy or asthma were studied for over 10 weeks per subject on average; 25 participants developed an asthma exacerbation. Detection of HRVs in the preceding 5 days was the most common attributable exposure related to exacerbation. Compared with other infections, those by a minor group A HRV were 4.4- fold more likely to cause exacerbation (P = 0.038). Overall, sputum neutrophils and the burden of rhinovirus in the lower airway were similar in control subjects without atopy and the asthma group. However, among HRV-infected participants with asthma, exacerbations were associated with greater sputum neutrophil counts (P = 0.005). CONCLUSIONS: HRV infection is a frequent cause of exacerbations in adults with asthma and a cold, and there may be group-specific differences in severity of these events. The absence of large differences in viral burden among groups suggests differential lower airway sensitization to the effects of neutrophilic inflammation in the patients having exacerbations. SN - 1535-4970 UR - https://www.unboundmedicine.com/medline/citation/21816938/Lower_airway_rhinovirus_burden_and_the_seasonal_risk_of_asthma_exacerbation_ L2 - http://www.atsjournals.org/doi/full/10.1164/rccm.201103-0585OC?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -