The Relationship of Rhinovirus‐Associated Asthma Hospitalizations with Inhaled Corticosteroids and Smoking
Departments of 1Medicine, 2Preventive Medicine, and 3Biostatistics, 4Division of Allergy, Pulmonary, and Critical Care Medicine, 5Center for Health Services Research, and 6Center for Education and Research on Therapeutics, Vanderbilt University School of Medicine, and 7Mid‐South Geriatric Research Education and Clinical Center, Quality Scholars Program, VA Tennessee Valley Health Care System, Nashville; 8Section of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin, Madison; 9Division of Clinical Immunology, Johns Hopkins School of Medicine, Baltimore, Maryland
Background.
Although rhinovirus (RV) respiratory infections trigger asthma exacerbations, the etiologic association between this virus and severe exacerbations, as well as the clinical characteristics of adults at risk for RV‐associated asthma that necessitates hospitalization, have not been established.
Methods.During 1999–2003, we conducted a cohort study of 101 adults prospectively enrolled at hospital admission for an asthma exacerbation. Patient characteristics and frequencies of RV in nasal specimens were analyzed, by reverse‐transcription polymerase chain reaction (RT‐PCR), at asthma‐related hospital admission and at a 3‐month convalescent follow‐up visit.
Results.RV was detected by RT‐PCR in 21% of hospitalized patients over a 4‐year period and in 1.3% of patients who returned for a 3‐month follow‐up visit. RV detection was strongly associated with hospitalization for asthma (adjusted odds ratio [OR], 15.1 [95% confidence interval {CI}, 1.88–121.4]). After adjustment for baseline asthma severity, RV‐positive patients were more likely than RV‐negative patients to be current smokers and nonusers of inhaled corticosteroids (ICSs) (adjusted OR, 11.18 [95% CI, 2.37–52.81]; 
).
Conclusions.RV respiratory infection is an etiologic agent in severe asthma exacerbations necessitating hospitalization in adults. Compared with hospitalized patients with asthma who were RV negative, RV‐positive patients were significantly more likely to be smokers and nonusers of ICSs.
Received 9 November 2005; accepted 18 January 2006; electronically published 27 April 2006.
Cited by
Online publication date: 1-Mar-2008.
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Online publication date: 1-Jun-2007.
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Presented in part: American Academy of Asthma Allergy and Immunology Meeting, San Antonio, Texas, March 2005 (abstract 685).
Potential conflicts of interest: none reported.
Financial support: National Institutes of Health (grants 5 R01 AI054660 and 5 R01 HL069949 to R.S.P.; grants KO8 AI01582, MO1 RR00095, UO1 HL72471, and R01 AI50884 to T.V.H.); American Lung Association (Clinical Research Grant to T.V.H.).