The relationship of rhinovirus-associated asthma hospitalizations with inhaled corticosteroids and smoking

Daniel L Venarske, William W Busse, Marie R Griffin, Tebeb Gebretsadik, Ayumi K Shintani, Patricia A Minton, R Stokes Peebles, Robert Hamilton, Elizabeth Weisshaar, Rose Vrtis, Stanley B Higgins, Tina V Hartert, Daniel L Venarske, William W Busse, Marie R Griffin, Tebeb Gebretsadik, Ayumi K Shintani, Patricia A Minton, R Stokes Peebles, Robert Hamilton, Elizabeth Weisshaar, Rose Vrtis, Stanley B Higgins, Tina V Hartert

Abstract

Background: Although rhinovirus (RV) respiratory infections trigger asthma exacerbations, the etiologic association between this virus and severe exacerbations, as well as the clinical characteristics of adults at risk for RV-associated asthma that necessitates hospitalization, have not been established.

Methods: During 1999-2003, we conducted a cohort study of 101 adults prospectively enrolled at hospital admission for an asthma exacerbation. Patient characteristics and frequencies of RV in nasal specimens were analyzed, by reverse-transcription polymerase chain reaction (RT-PCR), at asthma-related hospital admission and at a 3-month convalescent follow-up visit.

Results: RV was detected by RT-PCR in 21% of hospitalized patients over a 4-year period and in 1.3% of patients who returned for a 3-month follow-up visit. RV detection was strongly associated with hospitalization for asthma (adjusted odds ratio [OR], 15.1 [95% confidence interval {CI}, 1.88-121.4]). After adjustment for baseline asthma severity, RV-positive patients were more likely than RV-negative patients to be current smokers and nonusers of inhaled corticosteroids (ICSs) (adjusted OR, 11.18 [95% CI, 2.37-52.81]; P=.002).

Conclusions: RV respiratory infection is an etiologic agent in severe asthma exacerbations necessitating hospitalization in adults. Compared with hospitalized patients with asthma who were RV negative, RV-positive patients were significantly more likely to be smokers and nonusers of ICSs.

Figures

Table 1
Table 1
Demographic and asthma characteristics, including clinical presentation, disease severity, and spirometry, among 101 adult patients hospitalized for acute asthma, by rhinovirus (RV) infection status
Table 2
Table 2
Relationship of hospitalization for rhinovirus (RV)–associated asthma with inhaled corticosteroid (ICS) use and current smoking
Figure 1
Figure 1
Seasonality of rhinovirus (RV) isolation from December 1999 to December 2003, by month. The enrollment period was from 6 December 1999 through 11 December 2003

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