The relationship of rhinovirus-associated asthma hospitalizations with inhaled corticosteroids and smoking.
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.
Venarske
Daniel L
DL
Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37230-8300 USA.
Busse
William W
WW
Griffin
Marie R
MR
Gebretsadik
Tebeb
T
Shintani
Ayumi K
AK
Minton
Patricia A
PA
Peebles
R Stokes
RS
Hamilton
Robert
R
Weisshaar
Elizabeth
E
Vrtis
Rose
R
Higgins
Stanley B
SB
Hartert
Tina V
TV
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
D000305:Adrenal Cortex Hormones; D012367:RNA, Viral; D007073:Immunoglobulin E