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

G V Guibas; M Tsolia; I Christodoulou; F Stripeli; Z Sakkou; N G Papadopoulos

doi:10.1111/cea.13124

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

Clin Exp Allergy. 2018 May;48(5):536-543. doi: 10.1111/cea.13124. Epub 2018 Apr 3.

Authors

G V Guibas^{1

2

3}, M Tsolia⁴, I Christodoulou⁴, F Stripeli⁴, Z Sakkou⁴, N G Papadopoulos^{1

2

3

4}

Affiliations

¹ Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.
² Allergy Department, Manchester University NHS Foundation Trust, Manchester, UK.
³ Paediatric Allergy Department, Manchester University NHS Foundation Trust, Manchester, UK.
⁴ 2nd Paediatric Clinic, University of Athens, Athens, Greece.

PMID: 29473978
DOI: 10.1111/cea.13124

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: One thousand two hundred and seven 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: Rhinovirus 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.

Keywords: asthma; asthma exacerbation; asthma-augmented influenza; common cold; virus.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Asthma / virology*
Child
Child, Preschool
Common Cold / complications*
Cross-Sectional Studies
Female
Humans
Infant
Influenza, Human / complications*
Male
Rhinovirus