Rhinovirus-associated pulmonary exacerbations show a lack of FEV1 improvement in children with cystic fibrosis.
BACKGROUND
Respiratory viral infections lead to bronchial inflammation in patients with cystic fibrosis, especially during pulmonary exacerbations. The aim of this study was to determine the impact of viral-associated pulmonary exacerbations in children with cystic fibrosis and failure to improve forced expiratory volume in 1 s (FEV1 ) after an appropriate treatment.


METHODS
We lead a pilot study from January 2009 until March 2013. Children with a diagnosis of cystic fibrosis were longitudinally evaluated three times: at baseline (Visit 1), at the diagnosis of pulmonary exacerbation (Visit 2), and after exacerbation treatment (Visit 3). Nasal and bronchial samples were analyzed at each visit with multiplex viral respiratory PCR panel (qualitative detection of 16 viruses). Pulmonary function tests were recorded at each visit, in order to highlight a possible failure to improve them after treatment. Lack of improvement was defined by an increase in FEV1 less than 5% between Visit 2 and Visit 3.


RESULTS
Eighteen children were analyzed in the study. 10 patients failed to improve by more than 5% their FEV1 between Visit 2 and Visit 3. Rhinovirus infection at Visit 2 or Visit 3 was the only risk factor significantly associated with such a failure (OR, 12; 95% CI, 1·3-111·3), P = 0·03.


CONCLUSIONS
Rhinovirus infection seems to play a role in the FEV1 recovery after pulmonary exacerbation treatment in children with cystic fibrosis. Such an association needs to be confirmed by a large-scale study because this finding may have important implications for pulmonary exacerbation management.
Centre de Ressources et de Compétences pour la Mucoviscidose, Hôpital Arnaud de Villeneuve, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France.|Centre Hospitalier Régional Universitaire de Montpellier, Université de Montpellier, Montpellier, France.
Mathias
http://orcid.org/0000-0002-0508-9476
M
Cousin
Centre Hospitalier Régional Universitaire de Montpellier, Université de Montpellier, Montpellier, France.|Département de Statistiques, U1046 INSERM, UMR9214 CNRS, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France.
Nicolas
N
Molinari
Centre Hospitalier Régional Universitaire de Montpellier, Université de Montpellier, Montpellier, France.|Laboratoire de virologie, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France.|INSERM, U1058, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France.
Vincent
V
Foulongne
Centre de Ressources et de Compétences pour la Mucoviscidose, Hôpital Arnaud de Villeneuve, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France.
Davide
D
Caimmi
Centre de Ressources et de Compétences pour la Mucoviscidose, Hôpital Arnaud de Villeneuve, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France.
Isabelle
I
Vachier
Centre de Ressources et de Compétences pour la Mucoviscidose, American Memorial Hospital, Reims Cedex, France.
Michel
M
Abely
Centre de Ressources et de Compétences pour la Mucoviscidose, Hôpital Arnaud de Villeneuve, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France.
Raphael
R
Chiron
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D003550:Cystic Fibrosis / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology / Q000821:virology; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008168:Lung / Q000503:physiopathology* / Q000821:virology; D008297:Male; D010850:Picornaviridae Infections / Q000150:complications* / Q000503:physiopathology / Q000821:virology; D010865:Pilot Projects; D012129:Respiratory Function Tests; D012141:Respiratory Tract Infections / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology; D012229:Rhinovirus / Q000187:drug effects / Q000302:isolation & purification*; D012307:Risk Factors
D000900:Anti-Bacterial Agents
children; cystic fibrosis; pulmonary exacerbations; respiratory viruses; rhinovirus