RSV Identified as Significant Contributor to COPD Exacerbations

Respiratory syncytial virus (RSV) is linked to approximately 8.7% of chronic obstructive pulmonary disease (COPD) exacerbations in European cohorts, with RSV-related exacerbations showing a tendency to resolve more quickly than those caused by other pathogens, according to a study published in the American Journal of Respiratory and Critical Care Medicine.

“Delineating how RSV contributes to COPD exacerbations is especially important in predicting the potential impact of recently available vaccines that are highly effective in preventing RSV lower respiratory tract disease in older adults,” explained Dexter Wiseman, PhD, National Heart and Lung Institute, Imperial College London, UK2. Chelsea and Westminster NHS Foundation Trust, UK, and coauthors.

The researchers recruited 377 patients across two sites in the UK and the Netherlands between November 13, 2017, and December 13, 2019. The participants were aged 40 years and older with a history of smoking (≥10 pack-years) and spirometry evidence of airflow obstruction (FEV₁/FVC ≤ 0.7). The research was approved by ethics committees in both countries, ensuring informed consent from all participants.

Clinical assessments were conducted every three to six months, monitoring participants for exacerbation symptoms. Exacerbations were defined as the emergence of two new symptoms over two consecutive days, with at least one classified as major. The study utilized both molecular testing and serological assays to identify RSV cases, analyzing nasopharyngeal swabs and sputum samples for viral presence.

Results showed that out of 310 attended exacerbation events, RSV was detected in 27 cases through molecular and serological testing. Specifically, 6 out of 297 nasopharyngeal swabs (2.02%) were positive for RSV, while 8 out of 104 sputum samples (7.69%) tested positive. The positivity rate for RSV was significantly higher in sputum samples compared with nasopharyngeal swabs (P = .0061).

Further analysis indicated that RSV-associated exacerbations were shorter in duration compared with those caused by other pathogens (Kruskal-Wallis ANOVA, P = .026). However, there were no significant differences in clinical severity metrics such as FEV1 change or C-reactive protein levels among different exacerbation causes, suggesting that while RSV may contribute to COPD exacerbations, its impact on overall disease severity may be comparable to other viral infections.

“We suggest that a rise in RSV N-specific antibody may be a useful additional diagnostic modality in retrospective identification of RSV disease in longitudinal studies, even after the rollout of vaccines aimed at prevention of RSV disease,” concluded the study authors.

Reference

Wiseman DJ, Thwaites RS, Ritchie AI, et al. RSV-related community COPD exacerbations and novel diagnostics: a binational prospective cohort study. Am J Respir Crit Care Med. doi:10.1164/rccm.202308-1320OC