In children with asthma exacerbations, respiratory pathogens were not associated with greater severity on presentation, but were associated with an increased risk for treatment failure, according to the results of a study published in Pediatrics. This risk was particularly associated with the presence of respiratory syncytial virus, influenza, and parainfluenza.
Although viruses trigger most asthma exacerbations in children, evidence is lacking as to pathogen-specific contributions to clinical outcomes. To better characterize the role these viruses play, Joanna Merckx, MD, from the Division of Infectious Diseases, Department of Pediatrics, at The Montreal Children’s Hospital and the Department of Epidemiology, Biostatistics, and Occupational Health at McGill University in Montreal, Quebec, Canada, and colleagues performed a secondary analysis of the Determinants of Oral Corticosteroid Responsiveness in Wheezing Asthmatic Youth (DOORWAY; ClinicalTrials.gov Identifier: NCT02013076) study. DOORWAY was a prospective cohort study of children presenting to the emergency department (ED) with moderate to severe asthma exacerbations.
The researchers investigated the association between pathogens and exacerbation severity and treatment failure, defined as hospital admission, an ED stay of longer than 8 hours, or relapse. They used logistic multivariate regression analyses to estimate average marginal effects.
Of the 958 children participating in the study, 61.7% were positive for one or more pathogens and 16.9% of children had a treatment failure. Although pathogen presence was not associated with a higher baseline severity of exacerbation, it was associated with a higher risk for treatment failure (20.7% vs 12.5%). Rhinovirus was the most common pathogen found (29.4%), but non-rhinovirus pathogens were also associated with an increased absolute risk or risk difference for treatment failure of 13.1%. The absolute risk for respiratory syncytial virus was 8.8%, 24.9% for influenza, and 34.1% for parainfluenza.
The investigators suggested further exploration of the efficacy of both pathogen-specific and nonspecific therapies to reduce the treatment failure rate in children with acute asthma, as well as the use of advanced and rapid pathogen identification in the ED.
Disclosures: Some authors report financial relationships with Boehringer Ingelheim, Merck Canada, GlaxoSmithKline, Novartis, Sanofi Regeneron, AstraZeneca, Sage Products LLC, and AbbVie.
Merckx J, Ducharme FM, Martineau C, et al. Respiratory viruses and treatment failure in children with asthma exacerbation. Pediatrics. 2018;142:e20174105.