Review
The relevance of respiratory viral infections in the exacerbations of chronic obstructive pulmonary disease—A systematic review

https://doi.org/10.1016/j.jcv.2014.06.025Get rights and content

Highlights

  • In AECOPD contribution of respiratory viruses is largely unclear.

  • Literature of the prevalence of respiratory viruses in AECOPD was systematically evaluated.

  • Rhino-/enterovirus, RSV and influenza virus are the most prevalent viruses in AECOPD.

  • Adenovirus, hMPV and bocavirus appear not to be associated with AECOPD.

  • Detection rates vary between respiratory tract for different viruses.

Abstract

Background

Despite the increasing knowledge on the role of viruses in exacerbations of COPD (AECOPD), it is less clear which viruses are involved and to what extent they contribute to exacerbations. This review aims to systematically combine and evaluate the available literature of the prevalence of respiratory viruses in patients with AECOPD, detected by PCR.

Methods

An electronic search strategy was performed on PubMed and Embase and reference lists were screened for eligible studies. Cross-sectional, prospective studies and case-control studies were included. The primary outcome measure was the prevalence of respiratory viruses (adenovirus, bocavirus, coronavirus, EBV, hMPV, influenza, parainfluenza, rhino-/enterovirus, RSV) in respiratory secretions of patients during an AECOPD. Secondary outcomes were the odds of the presence of the viruses in different respiratory secretions and the odds of the presence of viruses in upper and lower respiratory tract (URT/LRT) samples.

Results

Nineteen studies with 1728 patients were included. Rhino-/enteroviruses (16.39%), RSV (9.90%) and influenza (7.83%) were the most prevalent viruses detected with lower detection rates of coronaviruses (4.08%) and parainfluenza (3.35%). Adenovirus (2.07%), hMPV (2.78%) and bocaviruses (0.56%) appear to be rare causative agents of AECOPD. Definitive conclusions regarding the role of EBV cannot be made. Seven of the eight analyzed viruses had a higher prevalence in LRT samples. Coronaviruses were detected more frequently in the URT.

Conclusions

Respiratory viruses are frequently detected in both URT and LRT samples in AECOPD with rhino-/enteroviruses, RSV and influenza viruses the most prevalent viruses. Detection rates vary between the two sites for different viruses.

Abbreviations

AECOPD
acute exacerbation of chronic obstructive pulmonary disease
COPD
chronic obstructive pulmonary disease
EBV
Epstein–Barr virus
ECHO
enteric cytopathogenic human orphan
FEV1
forced expiratory volume in one second
hMPV
human metapneumovirus
ICTV
International Committee on Taxonomy of Viruses
LRT
lower respiratory tract
PCR
polymerase chain reaction
qRT-PCR
quantitative quantitative real time-polymerase chain reaction
QUADAS
quality assessment of diagnostic accuracy studies
RSV
respiratory syncytial virus
RT-PCR
reverse transcriptase-polymerase chain reaction
URT
upper respiratory tract

Keywords

Pulmonary disease, chronic obstructive
Exacerbation
Viruses
Polymerase chain reaction
Systematic review

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