Giuseppe
Emeritus
Upper-Respiratory Viral Infection, Biomarkers, and COPD Exacerbations (CHEST, abstract, edited)
[Source: Chest, full text: <cite cite="http://chestjournal.chestpubs.org/content/138/4/896.short?rss=1">Upper-Respiratory Viral Infection, Biomarkers, and COPD Exacerbations ? CHEST</cite>. Abstract, edited.]
Upper-Respiratory Viral Infection, Biomarkers, and COPD Exacerbations
1. Omar Kherad, MD, 2. Laurent Kaiser, MD, 3. Pierre-Olivier Bridevaux, MD, 4. Fran?ois Sarasin, MD, 5. Yves Thomas, PhD, 6. Jean-Paul Janssens, MD and 7. Olivier T. Rutschmann, MD
Author Affiliations
1. From the Department of Internal Medicine (Dr Kherad); Central Laboratory of Virology (Drs Kaiser and Thomas), Division of Infectious Diseases; Division of Pulmonary Diseases (Drs Bridevaux and Janssens); and Department of Community and Primary Care Medicine (Drs Sarasin and Rutschmann), Geneva?s University Hospitals and University of Geneva, Geneva, Switzerland.
1. Correspondence to: Omar Kherad, MD, Department of Internal Medicine, Geneva?s University Hospitals, and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil 1211, Geneva 14, Switzerland; e-mail: omarkherad@gmail.com
Abstract
Background:
Respiratory viruses frequently are recovered in the upper-respiratory tract during acute exacerbations of COPD (AECOPD), but their role as contributing pathogens remains unclear. The usefulness of procalcitonin and C-reactive protein as indicators of the presence or absence of viral infection in this setting also needs to be evaluated.
Methods:
The study was of a prospective cohort of patients with COPD admitted to the ED for AECOPD. Reverse transcriptase-polymerase chain reaction (RT-PCR) for 14 respiratory viruses was performed on nasopharyngeal swabs collected at admission and after recovery in stable condition.
Results:
Eighty-six patients (mean age, 72 years; male, 64%) were included. During AECOPD, upper-respiratory viral infections were detected in 44 (51%) patients: picornavirus in 22, metapneumovirus in seven, coronavirus in eight, influenza A/B in two, parainfluenza in two, and respiratory syncytial virus in three. A dual infection was present in three patients. After recovery, viruses were detected in only eight (11%) of 71 patients (P < .001 compared with AECOPD phase). In five of these patients, no virus had been identified during the initial exacerbation, thus suggesting a new viral infection acquired during follow-up. During AECOPD, procalcitonin and C-reactive protein levels did not differ significantly between patients with or without a proven viral infection.
Conclusions:
Prevalence of upper-respiratory viral infection, as detected from nasopharyngeal swab by RT-PCR, is high in AECOPD and low after clinical recovery, suggesting that AECOPD frequently are triggered by viral infections initiated in the upper-respiratory tract. In our study, serum procalcitonin and C-reactive protein did not discriminate virus-associated exacerbations from others.
Trial registration: clinicaltrials.gov; Identifier: NCT00448604.
Footnotes
* Funding/Support: This work was performed at Geneva?s University Hospitals and Faculty of Medicine, University of Geneva, and was supported by the Pulmonary League of Geneva, Geneva?s University Hospitals, and a grant of the Swiss National Science Foundation attributed to Dr Kaiser (3200B-101670).
* Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).
#Abbreviations
AECOPD acute exacerbations of COPD
CRPC-reactive protein
OR odds ratio
PCR polymerase chain reaction
PCT procalcitonin
PEF peak expiratory flow
RSV respiratory syncytial virus
RT-PCR reverse transcriptase-polymerase chain reaction
URT upper-respiratory tract
* Received October 19, 2009.
* Accepted March 29, 2010.
* ? 2010 American College of Chest Physicians
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[Source: Chest, full text: <cite cite="http://chestjournal.chestpubs.org/content/138/4/896.short?rss=1">Upper-Respiratory Viral Infection, Biomarkers, and COPD Exacerbations ? CHEST</cite>. Abstract, edited.]
Upper-Respiratory Viral Infection, Biomarkers, and COPD Exacerbations
1. Omar Kherad, MD, 2. Laurent Kaiser, MD, 3. Pierre-Olivier Bridevaux, MD, 4. Fran?ois Sarasin, MD, 5. Yves Thomas, PhD, 6. Jean-Paul Janssens, MD and 7. Olivier T. Rutschmann, MD
Author Affiliations
1. From the Department of Internal Medicine (Dr Kherad); Central Laboratory of Virology (Drs Kaiser and Thomas), Division of Infectious Diseases; Division of Pulmonary Diseases (Drs Bridevaux and Janssens); and Department of Community and Primary Care Medicine (Drs Sarasin and Rutschmann), Geneva?s University Hospitals and University of Geneva, Geneva, Switzerland.
1. Correspondence to: Omar Kherad, MD, Department of Internal Medicine, Geneva?s University Hospitals, and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil 1211, Geneva 14, Switzerland; e-mail: omarkherad@gmail.com
Abstract
Background:
Respiratory viruses frequently are recovered in the upper-respiratory tract during acute exacerbations of COPD (AECOPD), but their role as contributing pathogens remains unclear. The usefulness of procalcitonin and C-reactive protein as indicators of the presence or absence of viral infection in this setting also needs to be evaluated.
Methods:
The study was of a prospective cohort of patients with COPD admitted to the ED for AECOPD. Reverse transcriptase-polymerase chain reaction (RT-PCR) for 14 respiratory viruses was performed on nasopharyngeal swabs collected at admission and after recovery in stable condition.
Results:
Eighty-six patients (mean age, 72 years; male, 64%) were included. During AECOPD, upper-respiratory viral infections were detected in 44 (51%) patients: picornavirus in 22, metapneumovirus in seven, coronavirus in eight, influenza A/B in two, parainfluenza in two, and respiratory syncytial virus in three. A dual infection was present in three patients. After recovery, viruses were detected in only eight (11%) of 71 patients (P < .001 compared with AECOPD phase). In five of these patients, no virus had been identified during the initial exacerbation, thus suggesting a new viral infection acquired during follow-up. During AECOPD, procalcitonin and C-reactive protein levels did not differ significantly between patients with or without a proven viral infection.
Conclusions:
Prevalence of upper-respiratory viral infection, as detected from nasopharyngeal swab by RT-PCR, is high in AECOPD and low after clinical recovery, suggesting that AECOPD frequently are triggered by viral infections initiated in the upper-respiratory tract. In our study, serum procalcitonin and C-reactive protein did not discriminate virus-associated exacerbations from others.
Trial registration: clinicaltrials.gov; Identifier: NCT00448604.
Footnotes
* Funding/Support: This work was performed at Geneva?s University Hospitals and Faculty of Medicine, University of Geneva, and was supported by the Pulmonary League of Geneva, Geneva?s University Hospitals, and a grant of the Swiss National Science Foundation attributed to Dr Kaiser (3200B-101670).
* Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).
#Abbreviations
AECOPD acute exacerbations of COPD
CRPC-reactive protein
OR odds ratio
PCR polymerase chain reaction
PCT procalcitonin
PEF peak expiratory flow
RSV respiratory syncytial virus
RT-PCR reverse transcriptase-polymerase chain reaction
URT upper-respiratory tract
* Received October 19, 2009.
* Accepted March 29, 2010.
* ? 2010 American College of Chest Physicians
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