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Original Research: Bronchiectasis |

The Role of Viral Infection in Pulmonary Exacerbations of Bronchiectasis in AdultsViral Infection in Bronchiectasis Exacerbation: A Prospective Study

Yong-hua Gao, PhD; Wei-jie Guan, PhD; Gang Xu, PhD; Zhi-ya Lin, MD; Yan Tang, MD; Zhi-min Lin, MM; Yang Gao, PhD; Hui-min Li, MT; Nan-shan Zhong, MD; Guo-jun Zhang, PhD; Rong-chang Chen, MD, FCCP
Author and Funding Information

From the Department of Respiratory and Critical Care Medicine (Drs Yong-hua Gao and Zhang), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan; State Key Laboratory of Respiratory Disease (Drs Yong-hua Gao, Guan, Xu, Lin, Tang, Yang Gao, Zhong, and Chen; Mr Lin; and Ms Li), National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong; and Department of Geriatrics (Dr Xu), Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.

CORRESPONDENCE TO: Rong-chang Chen, MD, FCCP, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd, Guangzhou, Guangdong 510120, China; e-mail: chenrc@vip.163.com


Drs Yong-hua Gao, Guan, and Xu contributed equally to this article.

FUNDING/SUPPORT: This work was supported by the Changjiang Scholars and Innovative Research Team in University ITR0961, The National Key Technology R&D Program of the 12th National Five-Year Development Plan [2012BAI05B01], and National Key Scientific & Technology Support Program: Collaborative innovation of clinical research for chronic obstructive pulmonary disease and lung cancer [No. 2013BAI09B09 to Drs Zhong and Chen].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(6):1635-1643. doi:10.1378/chest.14-1961
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BACKGROUND:  Although viral infections are a major cause of exacerbations in patients with chronic airway diseases, their roles in triggering bronchiectasis exacerbations in adults remain unclear. Therefore, we prospectively investigated the incidence and clinical impacts of viral infection in adults with bronchiectasis exacerbations.

METHODS:  The study cohort of 119 adults with bronchiectasis was followed up prospectively for 12 months. Nasopharyngeal swabs and sputum samples were assayed for 16 respiratory viruses, using polymerase chain reaction assays. Symptoms, spirometry, quality of life, bacterial cultures, and inflammatory markers were assessed during steady-state bronchiectasis and exacerbations.

RESULTS:  A total of 100 exacerbations were captured from 58 patients during 1-year follow-up. Respiratory viruses were found more frequently in nasopharyngeal swabs and sputum during bronchiectasis exacerbations (49 of 100, 49.0%) than during steady state (11 of 58, 18.9%; P < .001). The most common viruses found in patients experiencing exacerbations were coronavirus (19 of 65, 39.2%), rhinovirus (16 of 65, 24.6%), and influenza A/B viruses (16 of 65, 24.6%). Virus-positive exacerbations were associated with a greater increase in markers of systemic and airway inflammation (serum IL-6 and tumor necrosis factor-α; sputum IL-1β and tumor necrosis factor-α) compared with virus-negative exacerbations, but the differences in spirometric indexes, quality of life, and bacterial density were unremarkable. In receiver operating characteristics analysis, serum interferon-γ-induced protein 10 yielded an area under curve of 0.67 (95% CI, 0.53-0.77; P = .018). Furthermore, a greater proportion of patients with virus-positive exacerbations received IV antibiotics.

CONCLUSIONS:  Prevalence of viral infections, detected by polymerase chain reaction assay, is higher in cases of bronchiectasis exacerbations than in steady-state bronchiectasis, suggesting that respiratory viruses play crucial roles in triggering bronchiectasis exacerbations. The potential mechanisms of virus-induced bronchiectasis exacerbations merit further investigations.

TRIAL REGISTRY:  ClinicalTrials.gov; No.: NCT01801657; www.clinicaltrials.gov

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