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Original article
Incidence and clinical impact of respiratory viruses in adults with cystic fibrosis
  1. William G Flight1,2,
  2. Rowland J Bright-Thomas1,2,
  3. Peter Tilston3,
  4. Kenneth J Mutton2,3,
  5. Malcolm Guiver3,
  6. Julie Morris1,
  7. A Kevin Webb1,2,
  8. Andrew M Jones1,2
  1. 1University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
  2. 2Institute of Inflammation and Repair, University of Manchester, Manchester, UK
  3. 3Department of Virology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
  1. Correspondence to Dr William G Flight, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK; williamflight{at}hotmail.com

Abstract

Background Viral respiratory infection (VRI) is a common cause of pulmonary exacerbations in children with cystic fibrosis (CF). The importance of VRI in adult CF populations is unclear.

Objective To determine the incidence and clinical impact of VRI among adults with CF.

Methods One hundred adults with CF were followed up prospectively for 12 months. Sputum, nose swabs and throat swabs were collected every 2 months and at onset of pulmonary exacerbation. PCR assays for adenovirus, influenza A&B, human metapneumovirus, parainfluenza 1–3, respiratory syncytial virus and human rhinovirus were performed on each sample. Symptom scores, spirometry and inflammatory markers were measured at each visit.

Results One or more respiratory viruses were detected in 191/626 (30.5%) visits. Human rhinovirus accounted for 72.5% of viruses. Overall incidence of VRI was 1.66 (95% CI 1.39 to 1.92) cases/patient-year. VRI was associated with increased risk of pulmonary exacerbation (OR=2.19; 95% CI 1.56 to 3.08; p<0.001) and prescription of antibiotics (OR=2.26; 95% CI 1.63 to 3.13; p<0.001). Virus-positive visits were associated with higher respiratory symptom scores and greater C-reactive protein levels. Virus-positive exacerbations had a lower acute fall in FEV1 than virus-negative exacerbations (12.7% vs 15.6%; p=0.040). The incidence of exacerbations, but not VRI, was associated with greater lung function decline over 12 months (−1.79% per pulmonary exacerbation/year; 95% CI −3.4 to −0.23; p=0.025).

Conclusion VRI is common in adults with CF and is associated with substantial morbidity. Respiratory viruses are a potential therapeutic target in CF lung disease.

  • Cystic Fibrosis
  • Viral Infection
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