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Robert L. Atmar, MD; Elizabeth Guy, MD; Kalpalatha K. Guntupalli, MD; Janice L. Zimmerman, MD; Venkata D. Bandi, MD; Barbara D. Baxter, BS; Stephen B. Greenberg, MD

Arch Intern Med. 1998;158:2453-2459.

Background  Respiratory tract viral infections (RTVIs) have been identified frequently in association with asthma exacerbations in children, but few studies have shown similar rates of viral infections in adults with asthma. Further studies using newer diagnostic techniques to evaluate the frequency of RTVIs in adults with acute exacerbations of asthma need to be performed.

Methods  Twenty-nine asthmatic adults were recruited from the pulmonary clinic of an urban county hospital and were followed up in a longitudinal cohort study for signs and symptoms of asthma and RTVI. One hundred twenty-two asthmatic adults presenting to the emergency department (ED) of the same hospital with acute symptoms of asthma underwent evaluation for RTVI in a cross-sectional prevalence study. In both studies, respiratory secretions and paired serum samples were collected from subjects with acute wheezing episodes and evaluated using virus culture, serologic testing, and reverse transcription–polymerase chain reaction (RT-PCR).

Results  In the longitudinal cohort study, 138 respiratory illnesses, of which 87 were asthma exacerbations, were evaluated; 41% of all illnesses and 44% of asthma exacerbations were associated with an RTVI. In the ED study, 148 asthma exacerbations were evaluated; 55% were associated with an RTVI. An RTVI was identified in 21 (50%) of 42 of the subjects hospitalized in the ED study. Picornaviruses (rhinoviruses), coronaviruses, and influenza viruses were the most commonly identified causes of RTVI. Forty-six (60%) of the 77 picornavirus infections and 22 (71%) of the 31 coronavirus infections were identified only using RT-PCR.

Conclusions  Asthmatic exacerbations in adults are frequently associated with an RTVI. Identification of such infections often requires newer diagnostic methods, such as virus-specific RT-PCR. The high frequency of RTVIs identified in association with asthmatic exacerbations in adults from the inner city suggests that strategies for the prevention of RTVI should be targeted toward this population.

From the Departments of Medicine (Drs Atmar, Guy, Guntupalli, Zimmerman, Bandi, and Greenberg) and Microbiology and Immunology (Drs Atmar and Greenberg and Ms Baxter), Baylor College of Medicine, and the Medicine Service, Ben Taub General Hospital (Drs Atmar, Guy, Guntupalli, Zimmerman, Bandi, and Greenberg), Houston, Tex.

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