Navanandan Nidhya, Jackson Nathan D, Hamlington Katharine L, Everman Jamie L, Pruesse Elmar, Secor Elizabeth A, Stewart Zoe, Diener Katrina, Hardee Isabel, Edid Alec, Sulbaran Helio, Mistry Rakesh D, Florin Todd A, Yoder Angela C, Moore Camille M, Szefler Stanley J, Liu Andrew H, Seibold Max A
Section of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, Colo.
Center for Genes, Environment and Health, National Jewish Health, Denver, Colo.
J Allergy Clin Immunol Pract. 2025 Jan;13(1):95-104.e5. doi: 10.1016/j.jaip.2024.09.020. Epub 2024 Oct 3.
Although respiratory viruses are common triggers of asthma exacerbations, the influence of viral infection characteristics on exacerbation presentation and treatment response in the pediatric emergency department (ED) is unclear.
To assess viral infection characteristics of children experiencing ED asthma exacerbations and to test their associations with severity and treatment response.
This is a prospective study of children, aged 4 to 18 years, who received standard ED asthma exacerbation treatment with inhaled bronchodilators and systemic corticosteroids. Nasal swabs collected for viral metagenomic analyses determined virus presence, load, and species. Outcomes included exacerbation severity (Pediatric Asthma Severity [PAS] score, clinician impression, and vital signs) and treatment response (discharge home without needing additional asthma therapies).
Of 107 children, 47% had moderate/severe exacerbations by PAS and 64% demonstrated treatment response. Viral metagenomic analysis on nasal swabs from 73 children detected virus in 86%, with 10 different species identified, primarily rhinovirus A (RV-A), RV-C, and enterovirus D68. Exacerbations involving RV-A were milder (odds ratio [OR] = 0.25; 95% confidence interval [CI] = 0.07-0.83) and tended to be more responsive to treatment than non-RV-A infections, whereas exacerbations involving enterovirus D68 were more severe (OR = 8.3; 95% CI = 1.3-164.7) and had no treatment response association. Viral load was not associated with treatment response but exhibited a strong linear relationship with heart rate (r = 0.48), respiratory rate (r = 0.25), and oxygen saturation (r = -0.25), indicative of severity.
The majority of ED asthma exacerbations are triggered by respiratory viruses. Viral species are associated with severity and treatment response, suggesting that early pathogen detection could inform ED treatment decisions. Additional studies are needed to identify differences in pathobiology underlying exacerbations triggered by different viral species, and how to effectively treat these heterogeneous exacerbations.
尽管呼吸道病毒是哮喘急性加重的常见诱因，但病毒感染特征对儿科急诊科（ED）急性加重表现及治疗反应的影响尚不清楚。
评估急诊科哮喘急性加重患儿的病毒感染特征，并检测其与严重程度及治疗反应的关联。
这是一项针对4至18岁儿童的前瞻性研究，这些儿童接受了吸入支气管扩张剂和全身性皮质类固醇的标准急诊科哮喘急性加重治疗。收集鼻拭子进行病毒宏基因组分析，以确定病毒的存在、载量和种类。结局指标包括急性加重严重程度（儿科哮喘严重程度[PAS]评分、临床医生印象和生命体征）及治疗反应（无需额外哮喘治疗即可出院回家）。
107名儿童中，47%根据PAS有中度/重度急性加重，64%表现出治疗反应。对73名儿童的鼻拭子进行病毒宏基因组分析，86%检测到病毒，鉴定出10种不同病毒种类，主要为鼻病毒A（RV-A）、RV-C和肠道病毒D68。涉及RV-A的急性加重较轻（优势比[OR]=0.25；95%置信区间[CI]=0.07-0.83），且与非RV-A感染相比，对治疗的反应往往更好；而涉及肠道病毒D68的急性加重更严重（OR=8.3；95%CI=1.3-164.7），且与治疗反应无关联。病毒载量与治疗反应无关，但与心率（r=0.48）、呼吸频率（r=0.25）和血氧饱和度（r=-0.25）呈强线性关系，提示病情严重程度。
大多数急诊科哮喘急性加重由呼吸道病毒引发。病毒种类与严重程度及治疗反应相关，这表明早期病原体检测可为急诊科治疗决策提供依据。需要进一步研究以确定不同病毒种类引发急性加重的病理生物学差异，以及如何有效治疗这些异质性急性加重。
