Kling S, Donninger H, Williams Z, Vermeulen J, Weinberg E, Latiff K, Ghildyal R, Bardin P
Department of Paediatrics and Lung Unit, University of Stellenbosch, Cape Town, South Africa.
Clin Exp Allergy. 2005 May;35(5):672-8. doi: 10.1111/j.1365-2222.2005.02244.x.
Rhinoviruses (RVs) are believed to cause most asthma exacerbations but their role in the severity of acute asthma and subsequent recovery of airway function is not defined. The importance of atopy in virus-host interactions is also not clear.
We postulated that RV infection and atopic skin prick responses influence the severity of asthma exacerbations as measured by peak expiratory flow (PEF).
Patients aged 4-12 years admitted with acute severe asthma to a hospital emergency room (ER) were recruited. PEF measurements were obtained and nasal aspirates (NA) were taken. Atopy was diagnosed by skin prick responses to allergen and the presence of RV RNA and respiratory syncytial virus (RSV) RNA in NAs was detected using validated PCR assays. Patients were restudied after 6 weeks and after 6 months.
Fifty children with acute asthma (mean age+/-SD, 7.4+/-2.7) were enrolled; atopy was present in 37 (74%). RV RNA was detected in 41 (82%) and RSV RNA in six (12%) subjects. After 6 weeks 41 patients were restudied and RV RNA was again detected in 18 (44%). RV RNA was detected after 6 months in four of 16 patients restudied (25%; P=0.008 vs. ER) and in two of nine children from a control group with stable asthma (22%; P=0.009 vs. ER). Overall PEF measurements were reduced in asthmatics admitted to ER (% predicted, 63.4+/-16.4%) but did not differ between patients with RV RNA, RSV RNA or neither virus present. In subjects with RV RNA detectable in ER and after 6 weeks, measurements of PEF in ER were significantly lower than in patients in whom RV RNA was present in ER but absent after 6 weeks (P=0.009). Regression analysis linked persistence of RV RNA, but not skin prick responses to allergen, to severity of PEF reductions in ER.
RV RNA was detectable in >40% of asthmatic children 6 weeks after an acute exacerbation. Asthma exacerbations were more severe in patients with persistence of RV RNA suggesting that the severity of acute asthma may be linked to prolonged and possibly more severe RV infections.
鼻病毒（RV）被认为是导致大多数哮喘急性发作的原因，但其在急性哮喘严重程度及随后气道功能恢复中的作用尚不清楚。特应性在病毒与宿主相互作用中的重要性也不明确。
我们推测RV感染和特应性皮肤点刺反应会影响以呼气峰值流速（PEF）衡量的哮喘急性发作的严重程度。
招募4至12岁因急性重度哮喘入住医院急诊室（ER）的患者。测量PEF并采集鼻吸液（NA）。通过对过敏原的皮肤点刺反应诊断特应性，使用经过验证的PCR检测法检测NA中RV RNA和呼吸道合胞病毒（RSV）RNA的存在情况。在6周和6个月后对患者进行复查。
纳入50名急性哮喘儿童（平均年龄±标准差，7.4±2.7岁）；37名（74%）患有特应性。41名（82%）受试者检测到RV RNA，6名（12%）检测到RSV RNA。6周后对41名患者进行复查，18名（44%）再次检测到RV RNA。在复查的16名患者中，4名（25%）在6个月后检测到RV RNA（与急诊室相比，P = 0.008），在9名哮喘病情稳定的对照组儿童中有2名（22%）检测到（与急诊室相比，P = 0.009）。入住急诊室的哮喘患者总体PEF测量值降低（预测值百分比，63.4±16.4%），但RV RNA、RSV RNA阳性或均未检测到病毒的患者之间无差异。在急诊室及6周后可检测到RV RNA的受试者中，急诊室的PEF测量值显著低于急诊室时检测到RV RNA但6周后未检测到的患者（P = 0.009）。回归分析表明，RV RNA的持续存在而非对过敏原的皮肤点刺反应与急诊室PEF降低的严重程度相关。
急性发作6周后，超过40%的哮喘儿童可检测到RV RNA。RV RNA持续存在的患者哮喘急性发作更严重，这表明急性哮喘的严重程度可能与RV感染持续时间延长及可能更严重有关。
