Regional, age and respiratory-secretion-specific prevalence of respiratory viruses associated with asthma exacerbation: a literature review

Abstract

Despite increased understanding of how viral infection is involved in asthma exacerbations, it is less clear which viruses are involved and to what extent they contribute to asthma exacerbations. Here, we sought to determine the prevalence of different respiratory viruses during asthma exacerbations. Systematic computerized searches of the literature up to June 2017 without language limitation were performed. The primary focus was on the prevalence of respiratory viruses, including AdV (adenovirus), BoV (bocavirus), CoV (coronavirus), CMV (cytomegalovirus), EnV (enterovirus), HSV (herpes simplex virus), IfV (influenza virus), MpV (metapneumovirus), PiV (parainfluenzavirus), RV (rhinovirus) and RSV (respiratory syncytial virus) during asthma exacerbations. We also examined the prevalence of viral infection stratified by age, geographic region, type of respiratory secretion, and detection method. Sixty articles were included in the final analysis. During asthma exacerbations, the mean prevalence of AdV, BoV, CoV, CMV, EnV, HSV, IfV, MpV, PiV, RV and RSV was 3.8%, 6.9%, 8.4%, 7.2%, 10.1%, 12.3%, 10.0%, 5.3%, 5.6%, 42.1% and 13.6%, respectively. EnV, MPV, RV and RSV were more prevalent in children, whereas AdV, BoV, CoV, IfV and PiV were more frequently present in adults. RV was the major virus detected globally, except in Africa. RV could be detected in both the upper and lower airway. Polymerase chain reaction was the most sensitive method for detecting viral infection. Our findings indicate the need to develop prophylactic polyvalent or polyvirus (including RV, EnV, IfV and RSV) vaccines that produce herd immunity and reduce the healthcare burden associated with virus-induced asthma exacerbations.

Multi‐season analyses of causative pathogens in children hospitalized with asthma exacerbation

“…In this study, RV (48%) was the most detected virus among subjects with asthma exacerbation followed by RSV (6%), and the age on admission was significantly higher in the RV group than in the RSV group. The detection frequency of RV and RSV in our study was consistent with that in previous reports on the relationship between causative viruses and exacerbation in asthmatic patients, suggesting that our study illustrates the actual virus prevalence associated with asthma exacerbation . Heymann et al reported prevalence of rhinovirus infection was much less in the wheezing patients aged <3 years compared to those above the age.…”

“…Respiratory viral infections are associated with the pathophysiology of childhood asthma exacerbation . The major pathogens involved are human rhinovirus (RV), respiratory syncytial virus (RSV), enterovirus (EV), influenza virus, and human metapneumovirus (hMPV) . In previous studies, RSV has been associated with wheezing during infancy, whereas RV has been detected more frequently in school‐age children with wheezing .…”

Beyond Respiratory Syncytial Virus and Rhinovirus in the Pathogenesis and Exacerbation of Asthma

“…25 Although hMPV causes wheezing and lower respiratory tract symptoms, the contribution of hMPV to asthma exacerbations varies among different populations. In those with asthma exacerbations, the detection rate of hMPV is approximately 5% worldwide, 4 whereas in those with hMPV LRTI a much higher proportion have a diagnosis of asthma. In a study of children with hMPV LRTIs in the United States, 14% to 33% carried a diagnosis of asthma or history of wheezing.…”

“…It has long been identified as a precipitant of asthma exacerbations in all age groups. 2,4,45 In people with asthma exacerbations, the detection rate of influenza virus is approximately 10% worldwide, 4 but, during a flu season, the prevalence of influenza viruses can be as high as 20% in wheezing infants and 20% to 25% in adults with acute asthma exacerbations. 2,46,47 Although involvement of influenza virus is common in asthma exacerbation, influenza virus is an infrequent cause of acute wheezing illness in younger children.…”

“…These viruses have also been shown to be associated with asthma exacerbations. 4,5 RV and RSV are the most frequently detected pathogens (see Table 1), with RSV more prevalent in younger children in winter months and RV more prevalent in older children. 2 There is a large body of evidence implicating the association of RV [6][7][8] and RSV 9,10 with the subsequent development of recurrent wheezing and/or asthma.…”