title: The relationship of rhinovirus-associated asthma hospitalizations with inhaled corticosteroids and smoking.
abstract: 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]; P=.002).
  
  
  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.
authors.affiliation: Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37230-8300 USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Venarske
authors.forename: William W
authors.initials: WW
authors.lastname: Busse
authors.forename: Marie R
authors.initials: MR
authors.lastname: Griffin
authors.forename: Tebeb
authors.initials: T
authors.lastname: Gebretsadik
authors.forename: Ayumi K
authors.initials: AK
authors.lastname: Shintani
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Minton
authors.forename: R Stokes
authors.initials: RS
authors.lastname: Peebles
authors.forename: Robert
authors.initials: R
authors.lastname: Hamilton
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Weisshaar
authors.forename: Rose
authors.initials: R
authors.lastname: Vrtis
authors.forename: Stanley B
authors.initials: SB
authors.lastname: Higgins
authors.forename: Tina V
authors.initials: TV
authors.lastname: Hartert
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D001249:Asthma / Q000453:epidemiology / Q000503:physiopathology / Q000821:virology*; D012634:Bodily Secretions / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D010850:Picornaviridae Infections / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology / Q000821:virology; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012229:Rhinovirus / Q000302:isolation & purification*; D012307:Risk Factors; D012621:Seasons; D012720:Severity of Illness Index; D012907:Smoking
chemical_list: D000305:Adrenal Cortex Hormones; D012367:RNA, Viral; D007073:Immunoglobulin E