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

TLDR

To investigate whether upper and lower respiratory viral infections are linked to acute asthma exacerbations in schoolchildren, the study examined 108 9‑ to 11‑year‑olds in Southampton over 13 months using diary cards and peak‑flow monitoring to collect early respiratory samples and detect viral infections and exacerbations. A community‑based longitudinal design combined diary‑card symptom reporting, peak‑flow measurements, and PCR or conventional viral testing to identify respiratory viruses and correlate them with reported exacerbations and computer‑identified symptom episodes. Viruses—predominantly rhinovirus—were detected in 80–85 % of wheeze, reduced peak‑flow, and upper‑respiratory symptom episodes, with a median 14‑day duration and a median peak‑flow drop of 81 L/min, indicating that viral infections account for most asthma exacerbations in this age group.

Abstract

<h3>Abstract</h3> <b>Objective</b>: To study the association between upper and lower respiratory viral infections and acute exacerbations of asthma in schoolchildren in the community. <b>Design</b>: Community based 13 month longitudinal study using diary card respiratory symptom and peak expiratory flow monitoring to allow early sampling for viruses. <b>Subjects</b>: 108 Children aged 9-11 years who had reported wheeze or cough, or both, in a questionnaire. <b>Setting</b>: Southampton and surrounding community. <b>Main outcome measures</b>: Upper and lower respiratory viral infections detected by polymerase chain reaction or conventional methods, reported exacerbations of asthma, computer identified episodes of respiratory tract symptoms or peak flow reductions. <b>Results</b>: Viruses were detected in 80% of reported episodes of reduced 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 median duration 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. <b>Conclusions</b>: This study supports the hypothesis that upper respiratory viral infections are associated with 80-85% of asthma exacerbations in school age children. <h3>Key messages</h3> 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