PURPOSE OF THE STUDY.
To examine the influence of viral respiratory infection (VRI) on treatment response in acute asthma.
A total of 218 children (mean age, 6.6 years) with acute asthma were recruited.
Clinical symptoms were recorded, an asthma severity score was determined, and, whenever possible, a per-nasal aspirate was obtained for detection of viruses. Each child’s response to inhaled β2-agonists was assessed after 6, 12, and 24 hours.
The 168 children with VRI symptoms received more treatment with inhaled β2-agonists after 6 hours (P = .01), 12 hours (P = .002), and 24 hours (P = .0005) compared with the 50 children without such symptoms. Asthma severity did not differ between the 2 groups. A per-nasal aspirate was obtained from 77% of the children. The most frequently identified virus was rhinovirus (61.4%). Among children with symptoms of a VRI, those with rhinovirus had an impaired response to β2-agonists at 6 hours (P = .032).
Children with acute asthma and symptoms of VRI respond less effectively to β2-agonists after 6, 12, or 24 hours and thus may benefit from more intense therapy and monitoring.
An association between viral upper respiratory infections and exacerbations of asthma has been recognized for many years and, specifically, rhinovirus appears to have a unique and stronger relationship with acute asthma in children compared with other viruses. The authors state that the identification of VRI symptoms at the initial assessment would be of potential clinical importance because children presenting clinically with such symptoms may benefit from more intensive therapy and monitoring. Potential limitations to this study included (1) the investigators were unable to obtain a per-nasal aspirate for virus detection in all study subjects; (2) as opposed to the administration of β2-agonists as the primary measure of clinical response, more objective measures, such as spirometry or use of oral corticosteroids, may have been better measures to assess; and (3) the timing of other treatment administered before presentation to the emergency department, duration of the preceding infection, and/or allergen exposure was not completely controlled for in this study. Despite these issues, this study presents interesting clinical findings.
- Copyright © 2012 by the American Academy of Pediatrics