Giuseppe
Emeritus
[Source: Thorax, full page: (LINK). Abstract, edited.]
<CITE><ABBR>Thorax</ABBR> doi:10.1136/thoraxjnl-2013-204000 </CITE>
<CITE></CITE>
<CITE></CITE>Cystic fibrosis / Original article
Incidence and clinical impact of respiratory viruses in adults with cystic fibrosis
William G Flight 1,2, Rowland J Bright-Thomas 1,2, Peter Tilston 3, Kenneth J Mutton 2,3, Malcolm Guiver 3, Julie Morris 1, A Kevin Webb 1,2, Andrew M Jones 1,2
<SUP>1</SUP>University Hospital of South Manchester NHS Foundation Trust, Manchester, UK <SUP>2</SUP>Institute of Inflammation and Repair, University of Manchester, Manchester, UK <SUP>3</SUP>Department of Virology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
Correspondence to Dr William G Flight, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK; williamflight@hotmail.com
Received 10 June 2013 - Revised 9 September 2013 - Accepted 20 September 2013 - Published Online First 14 October 2013
Abstract
Background
Viral respiratory infection (VRI) is a common cause of pulmonary exacerbations in children with cystic fibrosis (CF). The importance of VRI in adult CF populations is unclear.
Objective
To determine the incidence and clinical impact of VRI among adults with CF.
Methods
One hundred adults with CF were followed up prospectively for 12 months. Sputum, nose swabs and throat swabs were collected every 2 months and at onset of pulmonary exacerbation. PCR assays for adenovirus, influenza A&B, human metapneumovirus, parainfluenza 1?3, respiratory syncytial virus and human rhinovirus were performed on each sample. Symptom scores, spirometry and inflammatory markers were measured at each visit.
Results
One or more respiratory viruses were detected in 191/626 (30.5%) visits. Human rhinovirus accounted for 72.5% of viruses. Overall incidence of VRI was 1.66 (95% CI 1.39 to 1.92) cases/patient-year. VRI was associated with increased risk of pulmonary exacerbation (OR=2.19; 95% CI 1.56 to 3.08; p<0.001) and prescription of antibiotics (OR=2.26; 95% CI 1.63 to 3.13; p<0.001). Virus-positive visits were associated with higher respiratory symptom scores and greater C-reactive protein levels. Virus-positive exacerbations had a lower acute fall in FEV<SUB>1</SUB> than virus-negative exacerbations (12.7% vs 15.6%; p=0.040). The incidence of exacerbations, but not VRI, was associated with greater lung function decline over 12 months (−1.79% per pulmonary exacerbation/year; 95% CI −3.4 to −0.23; p=0.025).
Conclusion
VRI is common in adults with CF and is associated with substantial morbidity. Respiratory viruses are a potential therapeutic target in CF lung disease.
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<CITE><ABBR>Thorax</ABBR> doi:10.1136/thoraxjnl-2013-204000 </CITE>
<CITE></CITE>
<CITE></CITE>Cystic fibrosis / Original article
Incidence and clinical impact of respiratory viruses in adults with cystic fibrosis
William G Flight 1,2, Rowland J Bright-Thomas 1,2, Peter Tilston 3, Kenneth J Mutton 2,3, Malcolm Guiver 3, Julie Morris 1, A Kevin Webb 1,2, Andrew M Jones 1,2
<SUP>1</SUP>University Hospital of South Manchester NHS Foundation Trust, Manchester, UK <SUP>2</SUP>Institute of Inflammation and Repair, University of Manchester, Manchester, UK <SUP>3</SUP>Department of Virology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
Correspondence to Dr William G Flight, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK; williamflight@hotmail.com
Received 10 June 2013 - Revised 9 September 2013 - Accepted 20 September 2013 - Published Online First 14 October 2013
Abstract
Background
Viral respiratory infection (VRI) is a common cause of pulmonary exacerbations in children with cystic fibrosis (CF). The importance of VRI in adult CF populations is unclear.
Objective
To determine the incidence and clinical impact of VRI among adults with CF.
Methods
One hundred adults with CF were followed up prospectively for 12 months. Sputum, nose swabs and throat swabs were collected every 2 months and at onset of pulmonary exacerbation. PCR assays for adenovirus, influenza A&B, human metapneumovirus, parainfluenza 1?3, respiratory syncytial virus and human rhinovirus were performed on each sample. Symptom scores, spirometry and inflammatory markers were measured at each visit.
Results
One or more respiratory viruses were detected in 191/626 (30.5%) visits. Human rhinovirus accounted for 72.5% of viruses. Overall incidence of VRI was 1.66 (95% CI 1.39 to 1.92) cases/patient-year. VRI was associated with increased risk of pulmonary exacerbation (OR=2.19; 95% CI 1.56 to 3.08; p<0.001) and prescription of antibiotics (OR=2.26; 95% CI 1.63 to 3.13; p<0.001). Virus-positive visits were associated with higher respiratory symptom scores and greater C-reactive protein levels. Virus-positive exacerbations had a lower acute fall in FEV<SUB>1</SUB> than virus-negative exacerbations (12.7% vs 15.6%; p=0.040). The incidence of exacerbations, but not VRI, was associated with greater lung function decline over 12 months (−1.79% per pulmonary exacerbation/year; 95% CI −3.4 to −0.23; p=0.025).
Conclusion
VRI is common in adults with CF and is associated with substantial morbidity. Respiratory viruses are a potential therapeutic target in CF lung disease.
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