Chest
Volume 147, Issue 6, June 2015, Pages 1635-1643
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Original Research: Bronchiectasis
The Role of Viral Infection in Pulmonary Exacerbations of Bronchiectasis in Adults: A Prospective Study

https://doi.org/10.1378/chest.14-1961Get rights and content

BACKGROUND

Although viral infections are a major cause of exacerbations in patients with chronic airway diseases, their roles in triggering bronchiectasis exacerbations in adults remain unclear. Therefore, we prospectively investigated the incidence and clinical impacts of viral infection in adults with bronchiectasis exacerbations.

METHODS

The study cohort of 119 adults with bronchiectasis was followed up prospectively for 12 months. Nasopharyngeal swabs and sputum samples were assayed for 16 respiratory viruses, using polymerase chain reaction assays. Symptoms, spirometry, quality of life, bacterial cultures, and inflammatory markers were assessed during steady-state bronchiectasis and exacerbations.

RESULTS

A total of 100 exacerbations were captured from 58 patients during 1-year follow-up. Respiratory viruses were found more frequently in nasopharyngeal swabs and sputum during bronchiectasis exacerbations (49 of 100, 49.0') than during steady state (11 of 58, 18.9'; P < .001). The most common viruses found in patients experiencing exacerbations were coronavirus (19 of 65, 39.2'), rhinovirus (16 of 65, 24.6'), and influenza A/B viruses (16 of 65, 24.6'). Virus-positive exacerbations were associated with a greater increase in markers of systemic and airway inflammation (serum IL-6 and tumor necrosis factor-α; sputum IL-1β and tumor necrosis factor-α) compared with virus-negative exacerbations, but the differences in spirometric indexes, quality of life, and bacterial density were unremarkable. In receiver operating characteristics analysis, serum interferon-γ-induced protein 10 yielded an area under curve of 0.67 (95' CI, 0.53-0.77; P = .018). Furthermore, a greater proportion of patients with virus-positive exacerbations received IV antibiotics.

CONCLUSIONS

Prevalence of viral infections, detected by polymerase chain reaction assay, is higher in cases of bronchiectasis exacerbations than in steady-state bronchiectasis, suggesting that respiratory viruses play crucial roles in triggering bronchiectasis exacerbations. The potential mechanisms of virus-induced bronchiectasis exacerbations merit further investigations.

TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT01801657; www.clinicaltrials.gov

ABBREVIATIONS

BE
bronchiectasis exacerbation
BSI
Bronchiectasis Severity Index
CAT
COPD Assessment Test
CFU
colony-forming unit
CRP
C-reactive protein
HCoV
human coronavirus
HRCT
high-resolution CT
IP-10
interferon-γ-induced protein 10
IQR
interquartile range
LCQ
Leicester Cough Questionnaire
NPS
nasopharyngeal swab
PCR
polymerase chain reaction
QoL
quality of life
SGRQ
St. George's Respiratory Questionnaire
TNF
tumor necrosis factor

Cited by (0)

Drs Yong-hua Gao, Guan, and Xu contributed equally to this article.

FUNDING/SUPPORT: This work was supported by the Changjiang Scholars and Innovative Research Team in University ITR0961, The National Key Technology R&D Program of the 12th National Five-Year Development Plan [2012BAI05B01], and National Key Scientific & Technology Support Program: Collaborative innovation of clinical research for chronic obstructive pulmonary disease and lung cancer [No. 2013BAI09B09 to Drs Zhong and Chen].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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