Distinction between rhinovirus-induced acute asthma and asthma-augmented influenza infection

Abstract

Background

Rhinovirus (RV) is an established trigger of asthma attacks, whereas such a link is less consistent for influenza virus (IFV).

Objective

In the context of precision medicine, we hypothesized that IFV infection may cause a condition essentially different from RV, and we investigated this by evaluating clinical characteristics of RV/IFV-positive and -negative children with respiratory symptoms and/or fever.

Methods

1207 children, 6-months to 13-years old, hospitalized for flu-like illness were recruited in this cross-sectional study. Collected information included demographics, medical history, symptoms/physical findings/diagnosis at presentation, and treatment. Nasal secretions were PCR-tested for IFV/RV. Associations were evaluated with adjusted logistic regression models.

Results

RV positivity was associated with an asthma-like presentation, including increased wheeze/effort of breathing/diagnosis of acute asthma, and decreased fever/vomiting. Conversely, IFV⁺ children presented with less wheeze/effort of breathing/diagnosis of acute asthma, while they were more frequently febrile. In those with previous asthma history, both viruses induced wheeze, however, IFV was uniquely associated with a more generalised and severe presentation including fever, rales, intercostal muscle retractions and lymphadenopathy. These symptoms were not seen in RV⁺ asthmatics, who had fewer systemic signs and more cough.

Conclusions and Clinical relevance

In children with respiratory symptoms and/or fever, RV but not IFV is associated with wheeze and an asthma-like presentation. In those with an asthma history, IFV causes more generalised and severe disease that may be better described as 'asthma-augmented influenza' rather than an 'asthma attack'. Differences in the acute conditions caused by these viruses should be considered in the design of epidemiological studies.

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from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2sSDwZC