The role of viral infection in pulmonary exacerbations of bronchiectasis in adults: A prospective study.

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The role of viral infection in pulmonary exacerbations of bronchiectasis in adults: A prospective study.

Chest. 2014 Nov 20;

Authors: Gao Y, Guan W, Xu G, Lin Z, Tang Y, Lin Z, Gao Y, Li H, Zhong N, Zhang G, Chen R

Abstract
Abstract: Background:Although viral infections are major cause of exacerbations in patients with chronic airway diseases, their roles in triggering bronchiectasis exacerbations in adults remain unclear. We therefore prospectively investigated the incidence and clinical impacts of viral infection in adults with bronchiectasis exacerbations. Methods:One hundred and nineteen adults with bronchiectasis were followed up prospectively for 12 months. Nasopharyngeal swab (NPS) and sputum were assayed for 16 respiratory viruses using polymerase chain reaction (PCR). Symptoms, spirometry, quality of life, bacterial culture and inflammatory makers were assessed, during steady-state and exacerbations. Results:A total of 100 exacerbations were captured from 58 patients during one-year follow-up. Respiratory viruses were found more frequently in NPS and sputum during bronchiectasis exacerbations (49/100, 49.0%) than steady-state (11/58, 18.9%, P<0.001). The most common viruses at exacerbations were coronavirus (19/65, 39.2%), rhinovirus (16/65, 24.6%) and influenza A/B (16/65, 24.6%). Virus-positive exacerbations were associated with a greater increase in makers of systemic and airway inflammation (serum IL-6 and TNF-a; sputum IL-1β and TNF-a) compared with virus-negative exacerbations, but the differences in spirometric indices, quality of life and bacterial density were unremarkable. In receiver operating characteristics analysis, serum interferon-γ-induced protein 10 (IP-10) yielded an area under curve of 0.67 (95%CI, 0.53-0.77; P=0.018). Furthermore, a greater proportion of patients with virus-positive exacerbations received intravenous antibiotics. Conclusions:Prevalence of viral infections, detected by PCR, is higher in exacerbations than in steady-state, suggesting that respiratory viruses play crucial roles in triggering bronchiectasis exacerbations. The potential mechanisms of virus-induced bronchiectasis exacerbations merit further investigations. Trial registration:clinicaltrials.gov; Identifier: NCT01801657.
Background: Although viral infections are major cause of exacerbations in patients with chronic airway diseases, their roles in triggering bronchiectasis exacerbations in adults remain unclear. We therefore prospectively investigated the incidence and clinical impacts of viral infection in adults with bronchiectasis exacerbations.
Methods: One hundred and nineteen adults with bronchiectasis were followed up prospectively for 12 months. Nasopharyngeal swab (NPS) and sputum were assayed for 16 respiratory viruses using polymerase chain reaction (PCR). Symptoms, spirometry, quality of life, bacterial culture and inflammatory makers were assessed, during steady-state and exacerbations.
Results: A total of 100 exacerbations were captured from 58 patients during one-year follow-up. Respiratory viruses were found more frequently in NPS and sputum during bronchiectasis exacerbations (49/100, 49.0%) than steady-state (11/58, 18.9%, P<0.001). The most common viruses at exacerbations were coronavirus (19/65, 39.2%), rhinovirus (16/65, 24.6%) and influenza A/B (16/65, 24.6%). Virus-positive exacerbations were associated with a greater increase in makers of systemic and airway inflammation (serum IL-6 and TNF-a; sputum IL-1β and TNF-a) compared with virus-negative exacerbations, but the differences in spirometric indices, quality of life and bacterial density were unremarkable. In receiver operating characteristics analysis, serum interferon-γ-induced protein 10 (IP-10) yielded an area under curve of 0.67 (95%CI, 0.53-0.77; P=0.018). Furthermore, a greater proportion of patients with virus-positive exacerbations received intravenous antibiotics.
Conclusions: Prevalence of viral infections, detected by PCR, is higher in exacerbations than in steady-state, suggesting that respiratory viruses play crucial roles in triggering bronchiectasis exacerbations. The potential mechanisms of virus-induced bronchiectasis exacerbations merit further investigations.
Trial registration: clinicaltrials.gov; Identifier: NCT01801657.

PMID: 25412225 [PubMed - as supplied by publisher]

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