Asthma + Respiratory Viral Infection = A Bad Combination :

When a child presents with an asthma exacerbation, our history taking may reveal that an underlying infection seemed to trigger the wheezing exacerbation. But does the addition of a viral pathogen combined with a predisposition to reactive airway disease mean treating that episode of asthma becomes all the more difficult?  Merckx et al. (10.1542/peds.2017-4105) decided to explore that question in an article being released this week from our journal.  The authors share data from a secondary analysis of a prospective cohort of children who presented to an emergency department with a moderate to severe asthma exacerbation.  Nasopharyngeal specimens were obtained and polymerase chain reaction (PCR) testing for viral etiology done for 27 respiratory pathogens to see if these pathogens were associated with a worse baseline exacerbation or a subsequent treatment failure.  While no particular pathogen was identified as making the baseline presentation worse than having no pathogen whatsoever, respiratory syncytial virus, influenza, and parainfluenza were found to have significant risk of treatment failure compared to no pathogen detected.  If ever there were an article to inject importance to giving influenza vaccine to all asthmatics this one is it. The study also stresses the importance of perhaps being even more aggressive at treating asthma in the setting of a viral pathogen co-morbidity. No guarantee you’ll breathe easier knowing what this article reveals about the dangers of a virus triggering a tougher exacerbation to conquer, but it at least may explain why your patient is not getting better as quickly as you might have expected.  And if the words in this blog don’t convince you of the article’s importance, check out the video abstract version and you’ll hear or better yet see directly from the authors as to why this study is well worth knowing about.