Factors associated with symptomatic rhinovirus infection in patients with COPD
Section snippets
Background
For many years human rhinovirus (HRV) infections have been recognized as the most frequent causes of the common cold.1, 2 Older studies using viral culture for diagnosis demonstrated a range of clinical syndromes ranging from asymptomatic infection to sinusitis and bronchitis.3 The use of molecular diagnostics such as reverse transcriptase polymerase chain reaction (RT-PCR) has allowed a greater appreciation of HRVs as the cause of lower respiratory illness and recent studies frequently link
Objectives
The purpose of this study was to compare host, virologic and environmental factors associated with symptomatic HRV infection.
Study design
We took advantage of a prior study of COPD and respiratory syncytial virus (RSV) in which a cohort of patients with COPD were evaluated every 2 months and for all respiratory illnesses for one year.13 Testing for rhinovirus was performed on samples from this prospective study of 127 persons with COPD. Nasal and sputum samples were stored at minus 80 °C until testing.
Human rhinovirus (HRV)
The real time reverse transcriptase polymerase chain reaction (RT-PCR) assay was performed using the iScript one step RT-PCR kit (BioRad Laboratories, Hercules, CA). Primers and probes were based on the methods published by Lu et al. with the following modification for the forward primer (5′-CYGCCZGCGTGGY-3′).14 The amplification was performed on a BioRad iCylcer with the following conditions: 10 min at 48 °C, 3 min at 95 °C and 45 cycles of 15 s at 95 °C and 1 min at 60 °C.
Rhinovirus sequencing
The 187 base pair
Results
One hundred twenty-seven subjects were enrolled and 110 completed the study. Nine participants withdrew from the study due to ill health and 8 died. Most participants (97%) were cared for by a pulmonologist, 46% had chronic sputum production, and the mean smoking history was 49 pack-years. Seventy-one (56%) had pulmonary function test results available with a mean forced expiratory volume at one second (FEV1) of 44 ± 19% of predicted. Sixty-nine percent used inhaled steroids and 20% received
Discussion
Our study, similar to published reports, demonstrates that HRV infection is common among persons with COPD and accounted for 19% of the illnesses over a one year period.4, 5, 6, 7, 8, 9, 10, 11 Rates of HRV infection in AECOPD have varied widely ranging from 3 to 36% depending on the type of testing used.16, 17, 18 Many prior studies did not include COPD patients in the stable state and those that did typically used a case–control study design.8 Our study involved intensive sampling of subjects
Funding
None.
Ethical approval
The study was approved by the Rochester General Hospital and the University of Rochester Research Subjects Review Board.
Competing interests
None of the authors have financial conflicts of interest which could potentially bias the results of the study. Dr. Falsey has served as a consultant for sanofipasteur, GSK Biologics, Medimmune, AstraZeneca and Novartis. Dr. Walsh has served as a consultant for Novartis, Alnylam, AstraZeneca, Medimmune and Boehringer Ingelheim. Dr. Gandhi has no conflicts to declare.
References (42)
- et al.
Respiratory viral infections in patients with chronic obstructive pulmonary disease
J Infect
(2005) - et al.
A community-based, time-matched, case–control study of respiratory viruses and exacerbations of COPD
Respir Med
(2007) - et al.
Viral epidemiology of acute exacerbations of chronic obstructive pulmonary disease
Pulm Pharmacol Ther
(2012) - et al.
Serum IP-10 as a biomarker of human rhinovirus infection at exacerbation of COPD
Chest
(2010) - et al.
How viral infections cause exacerbation of airway diseases
Chest
(2006) - et al.
Characterisation of a newly identified human rhinovirus, HRV-QPM, discovered in infants with bronchiolitis
J Clin Virol
(2007) - et al.
Rhinovirus infections in an industrial population. II. Characteristics of illnesses and antibody response
JAMA
(1967) - et al.
Rhinovirus infections in an industrial population. I. The occurrence of illness
N Engl J Med
(1966) Rhinoviruses
- et al.
Updates in the relationship between human rhinovirus and asthma
Allergy Asthma Immunol Res
(2012)