Asthma Control, Viral Infections, and Severity of Asthma Exacerbation Symptoms in Children Seen in the Emergency Department.
Monday, March 5, 2018
South Hall A2 (Convention Center)
Olga Hardin, MD, Darrell L. Dinwiddie, PhD, Sudeepa Bhattacharyya, PhD, Chunqiao Luo, MS, Ashley Stoner, MD, John C Kincaid, MD, Kurt Schwalm, BS, Thomas J Abramo, M.D., Tonya M Thompson, M.D., Stacie M. Jones, MD, FAAAAI, Richard C. Kurten, PhD, Joshua L. Kennedy, MD
RATIONALE: While rhinovirus (RV) infection is shown to be associated with asthma exacerbations, prior research has not identified reliable predictors of acute symptom severity in virus-related asthma exacerbations. We enrolled 97 subjects with asthma exacerbations in the emergency department (ED) to evaluate the effect of pre-existing asthma control on the severity of current illness.

METHODS: We prospectively enrolled children with physician diagnosed asthma and current wheezing who presented to Arkansas Children’s Hospital ED. The Asthma Control Test (ACT) was used to stratify well- (ACT>19) and poorly-controlled (ACT≤19) asthma, while Pediatric Respiratory Symptoms Score (PRSS) and Modified Jackson Criteria (MJC) were used to assess current symptoms. Nasopharyngeal swab samples were obtained for viral PCR and genome sequencing.

RESULTS: There were 28 well-controlled and 69 poorly-controlled asthmatics. Sixty-seven percent tested positive for a viral infection, RV most commonly (39.2%). Of those with poor control, 71.4% were infected vs. 60.7% of those with good control. In virally infected subjects, those who were poorly-controlled demonstrated more acute symptoms as compared to those who were well-controlled as measured with PRSS and MJC (p<0.05). The PRSS detected more acute symptoms in the poorly-controlled asthmatics with viral infection than those poorly-controlled asthmatics without infection. Subjects with well-controlled asthma and RV-induced exacerbations had higher viral loads than those with poor control (p<0.05).

CONCLUSIONS: Virally infected poorly-controlled asthmatics demonstrate more symptoms during exacerbations by PRSS and MJC, even when compared to uninfected poorly-controlled asthmatics. With RV infection, those with well-controlled asthma have higher viral loads than those with poorly-controlled, suggesting intact immune responses.