Asthma and lower airway disease
Weekly monitoring of children with asthma for infections and illness during common cold seasons

https://doi.org/10.1016/j.jaci.2010.01.059Get rights and content

Background

Exacerbations of childhood asthma and rhinovirus infections both peak during the spring and fall, suggesting that viral infections are major contributors to seasonal asthma morbidity.

Objectives

We sought to evaluate rhinovirus infections during peak seasons in children with asthma and to analyze relationships between viral infection and illness severity.

Methods

Fifty-eight children aged 6 to 8 years with asthma provided 5 consecutive weekly nasal lavage samples during September and April; symptoms, medication use, and peak flow were recorded. Rhinoviruses were identified by using multiplex PCR and partial sequencing of viral genomes.

Results

Viruses were detected in 36% to 50% of the specimens, and 72% to 99% of the viruses were rhinoviruses. There were 52 different strains (including 16 human rhinovirus C) among the 169 rhinovirus isolates; no strains were found in more than 2 collection periods, and all but 2 children had a respiratory tract infection. Virus-positive weeks were associated with greater cold and asthma symptom severity (P < .0001 and P = .0002, respectively). Furthermore, virus-positive illnesses had increased duration and severity of cold and asthma symptoms and more frequent loss of asthma control (47% vs 22%, P = .008). Although allergen-sensitized versus nonsensitized children had the same number of viral infections, the former had 47% more symptomatic viral illnesses (1.19 vs 0.81 per month, P = .03).

Conclusions

Rhinovirus infections are nearly universal in children with asthma during common cold seasons, likely because of a plethora of new strains appearing each season. Illnesses associated with viruses have greater duration and severity. Finally, atopic asthmatic children experienced more frequent and severe virus-induced illnesses.

Key words

Asthma
children
viral respiratory tract infection
human rhinovirus
allergic sensitization
wheezing
cold symptoms
illness

Abbreviations used

HRV
Human rhinovirus
PEF
Peak expiratory flow

Cited by (0)

Supported by National Institutes of Health grant R01 HL080072.

Disclosure of potential conflict of interest: R. F. Lemanske, Jr, has given lectures for Merck and AstraZeneca and has consulted for AstraZeneca, Map Pharmaceuticals, Gray Consulting, Smith Research, Merck Childhood Asthma Network, Novartis, Quintiles/Innovax, RC Horowitz & Co, International Meetings and Science, and Scienomics. J. E. Gern has stock options in EraGen Biosciences and 3V Biosciences, has consulted for 3V Biosciences and Synairgen, and has received research support from AstraZeneca and Merck. The rest of the authors have declared that they have no conflict of interest.

These two authors contributed equally to this study.

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