title: Incidence and clinical impact of respiratory viruses in adults with cystic fibrosis.
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 FEV1 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).
  
  
  CONCLUSIONS
  VRI is common in adults with CF and is associated with substantial morbidity. Respiratory viruses are a potential therapeutic target in CF lung disease.
authors.affiliation: University Hospital of South Manchester NHS Foundation Trust, , Manchester, UK.
authors.forename: William G
authors.initials: WG
authors.lastname: Flight
authors.forename: Rowland J
authors.initials: RJ
authors.lastname: Bright-Thomas
authors.forename: Peter
authors.initials: P
authors.lastname: Tilston
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mutton
authors.forename: Malcolm
authors.initials: M
authors.lastname: Guiver
authors.forename: Julie
authors.initials: J
authors.lastname: Morris
authors.forename: A Kevin
authors.initials: AK
authors.lastname: Webb
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Jones
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D003550:Cystic Fibrosis / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D015994:Incidence; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018357:Respiratory Syncytial Virus Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013147:Spirometry; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: Cystic Fibrosis; Viral Infection