Lower Airway Rhinovirus Burden and the Seasonal Risk of Asthma Exacerbation
Lower Airway Rhinovirus Burden and the Seasonal Risk of Asthma Exacerbation
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DOI：
10.1164/rccm.201103-0585oc
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发表时间：
2011-11-01
影响因子：
24.7
通讯作者：
Jarjour, Nizar N.
中科院分区：
文献类型：
--
作者：
Denlinger, Loren C.;Sorkness, Ron L.;Jarjour, Nizar N.
基本原理：大多数哮喘急性发作是由病毒性上呼吸道疾病引起的。目前还不清楚是否人鼻病毒（HRV）诱导的急性加重与更大的病毒复制和嗜酸性炎症HRV colds.Objectives相比：评估病毒株和负载在一个前瞻性的哮喘队列在一个自然cold.Methods：成人入组的第一个迹象感冒，每天监测症状，药物使用，呼气流速峰值，直到解决。串行鼻灌洗和诱导痰样本进行了评估病毒拷贝数和炎性细胞counts.Measures和主要结果：共52人哮喘和14个对照组无过敏性或哮喘进行了研究，平均超过10周，每个主题，25名参与者开发了哮喘急性发作。在前5天内检测HRV是与急性加重相关的最常见归因暴露。与其他感染相比，由轻微A组HRV引起的感染导致急性加重的可能性高4.4倍（P = 0.038）。总的来说，痰中性粒细胞和鼻病毒在下呼吸道的负担是相似的对照组无过敏性和哮喘组。然而，在HRV感染的参与者与哮喘，急性发作与更大的痰中性粒细胞计数（P = 0.005）。结论：HRV感染是一个常见的原因急性发作的成人哮喘和感冒，并可能有组特异性差异，这些事件的严重程度。各组间病毒负荷无明显差异，提示急性加重患者下气道对嗜酸性炎症反应的敏感性不同。
Rationale: Most asthma exacerbations are initiated by viral upper respiratory illnesses. It is unclear whether human rhinovirus (HRV)-induced exacerbations are associated with greater viral replication and neutrophilic inflammation compared with HRV colds.Objectives: To evaluate viral strain and load in a prospective asthma cohort during a natural cold.Methods: Adults were enrolled at the first sign of a cold, with daily monitoring of symptoms, medication use, and peak expiratory flow rate until resolution. Serial nasal lavage and induced sputum samples were assessed for viral copy number and inflammatory cell counts.Measurements and Main Results: A total of 52 persons with asthma and 14 control subjects without atopy or asthma were studied for over 10 weeks per subject on average; 25 participants developed an asthma exacerbation. Detection of HRVs in the preceding 5 days was the most common attributable exposure related to exacerbation. Compared with other infections, those by a minor group A HRV were 4.4-fold more likely to cause exacerbation (P = 0.038). Overall, sputum neutrophils and the burden of rhinovirus in the lower airway were similar in control subjects without atopy and the asthma group. However, among HRV-infected participants with asthma, exacerbations were associated with greater sputum neutrophil counts (P = 0.005).Conclusions: HRV infection is a frequent cause of exacerbations in adults with asthma and a cold, and there may be group-specific differences in severity of these events. The absence of large differences in viral burden among groups suggests differential lower airway sensitization to the effects of neutrophilic inflammation in the patients having exacerbations.