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Am. J. Respir. Crit. Care Med., Volume 164, Number 9, November 2001, 1618-1623

Respiratory Viruses, Symptoms, and Inflammatory Markers in Acute Exacerbations and Stable Chronic Obstructive Pulmonary Disease

TERENCE SEEMUNGAL, RHIAN HARPER-OWEN, ANGSHU BHOWMIK, IVANA MORIC, GWENDOLYN SANDERSON, SIMON MESSAGE, PETER MACCALLUM, THOMAS W. MEADE, DONALD J. JEFFRIES, SEBASTIAN L. JOHNSTON, and JADWIGA A. WEDZICHA

Academic Departments of Respiratory Medicine and Virology, St. Bartholomew's and Royal London School of Medicine and Dentistry, London, UK; University Medicine, University of Southampton, Southampton, UK; National Heart and Lung Institute at St Mary's, Imperial College School of Medicine, London, UK; and Medical Research Council Epidemiology and Medical Care Unit, Wolfson Institute of Preventive Medicine, London, UK

The effects of respiratory viral infection on the time course of chronic obstructive pulmonary disease (COPD) exacerbation were examined by monitoring changes in systemic inflammatory markers in stable COPD and at exacerbation. Eighty-three patients with COPD (mean [SD] age, 66.6 [7.1] yr, FEV1, 1.06 [0.61] L) recorded daily peak expiratory flow rate and any increases in respiratory symptoms. Nasal samples and blood were taken for respiratory virus detection by culture, polymerase chain reaction, and serology, and plasma fibrinogen and serum interleukin-6 (IL-6) were determined at stable baseline and exacerbation. Sixty-four percent of exacerbations were associated with a cold occurring up to 18 d before exacerbation. Seventy-seven viruses (39 [58.2%] rhinoviruses) were detected in 66 (39.2%) of 168 COPD exacerbations in 53 (64%) patients. Viral exacerbations were associated with frequent exacerbators, colds with increased dyspnea, a higher total symptom count at presentation, a longer median symptom recovery period of 13 d, and a tendency toward higher plasma fibrinogen and serum IL-6 levels. Non-respiratory syncytial virus (RSV) respiratory viruses were detected in 11 (16%), and RSV in 16 (23.5%), of 68 stable COPD patients, with RSV detection associated with higher inflammatory marker levels. Respiratory virus infections are associated with more severe and frequent exacerbations, and may cause chronic infection in COPD. Prevention and early treatment of viral infections may lead to a decreased exacerbation frequency and morbidity associated with COPD.




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