Respiratory Syncytial and Other Virus Infections in Persons with Chronic Cardiopulmonary Disease

Am J Respir Crit Care Med Vol 160. pp 791–795, 1999 Internet address: www.atsjournals.org Respiratory Syncytial and Other Virus Infections in Persons with Chronic Cardiopulmonary Disease EDWARD E. WALSH, ANN R. FALSEY, and PATRICIA A. HENNESSEY Department of Medicine, Rochester General Hospital and the University of Rochester School of Medicine and Dentistry, Rochester, New York Respiratory syncytial virus (RSV) has been increasingly recognized as an important cause of serious respiratory illness in some adult populations, including those with underlying cardiopulmonary dis- eases. However, the precise incidence and the clinical impact of RSV in this group are unknown. Therefore, the incidence and clinical impact of RSV infection in persons with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) who reside in the community were prospectively evaluated over two consecutive winters in 134 persons. Eight RSV (incidence of 4.3 per 100 subject-winters), 13 influenza A (incidence of 7.0 per 100 subject-winters), seven rhinovirus, nine coronavirus, and two parainfluenza virus infections were identified. The clinical illnesses associated with RSV and influenza A virus were similar, causing both upper and lower respiratory signs and symptoms. The clinical impact was significant as three of eight RSV-infected subjects were hospitalized compared with six of 13 influenza A–infected persons and zero of seven rhinovirus-infected persons. Walsh EE, Falsey AR, Hennessey PA. Respiratory syncytial and other virus infections in persons with chronic cardiopulmonary disease. AM J RESPIR CRIT CARE MED 1999;160:791–795. Respiratory syncytial virus (RSV) is an RNA virus in the Para- myxovirus family and has long been recognized as the most important cause of respiratory tract infection in infants (1). Recently, RSV has also been identified as a cause of serious illness in certain adult populations, including the elderly and those with underlying chronic cardiopulmonary disorders (2– 5). In a recent study of persons over age 65, RSV infection was associated with 10% of winter hospitalizations for cardiopulmonary disease or flulike illness compared with 13% due to influenza A and B (2). In another study of adults hospitalized with pneumonia, RSV was the third most common pathogen identified, only slightly less frequent than pneumococcus and influenza A (4). In both of these hospital-based studies, underlying chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF) was present in approximately half of the patients. The role of viral infection, including RSV, in ex- acerbations of chronic bronchitis has been noted in a number of studies, although previous studies were generally small and diagnostic tests for RSV were relatively insensitive (6–14). Im- portantly, none of these reports studied chronic cardiac patients or described in detail the clinical outcome of RSV infection. In this report we describe the incidence and outcome of RSV infection in 134 community-dwelling adults with underlying COPD and/or CHF prospectively followed during two consecutive winters. The clinical impact of RSV infections is contrasted to other common respiratory viruses. METHODS Subjects Adults with a diagnosis of New York State Heart Association Class III or IV CHF or chronic lung disease were eligible to participate in the study. COPD was defined as a physician’s diagnosis of obstructive airway disease and a history of smoking. Patients with asthma were excluded. Subjects were recruited from the pulmonary and cardiac re- habilitation programs at Rochester General Hospital (Rochester, NY) or from the Department of Medicine cardiology practice. All subjects were required to sign informed consent according to the guide- lines of the University of Rochester and the Rochester General Hos- pital Human Subjects review boards. Enrollment and Study Period Recruitment took place in the month prior to the study period, which was mid November to mid April in two consecutive winters, 1996– 1997 and 1997–1998. All subjects underwent a standard history and physical examination of the cardiorespiratory systems. Demographic data, living situation including frequency of contact with children, medications, functional status as measured by Katz Activities of Daily Living (ADL) and the Lawton Scale of instrumental activities of daily living (IADL) were recorded (15, 16). Arterial oxygen saturation (Sa O2 ) was measured on room air unless the subject required constant supplemental oxygen. Blood samples for baseline viral serology were collected at enrollment. Cardiac ejection fraction, as determined by echocardiography, and/or percent predicted FEV 1 were recorded from medical records. Surveillance for Respiratory Illnesses Respiratory illnesses were monitored during the study period by a combination of active surveillance and passive reporting. Subjects were asked to contact study personnel if they had any symptoms con- sistent with a respiratory illness, such as nasal congestion, sore throat, new or increased cough or sputum production or dyspnea, and fever. Subjects were also to call if they experienced worsening of their baseline cardiopulmonary disease. Illness evaluation included a directed cardiopulmonary history and physical exam, Sa O2 measurement, na- (Received in original form January 4, 1999 and in revised form March 1, 1999) Presented in part at the Interscience Conference on Antimicrobial Agents and Chemotherapy, San Diego, California, September 1998. Supported by a grant from the National Institutes of Health (NIAID AI-45248). Correspondence and requests for reprints should be addressed to Edward E. Walsh, M.D., Rochester General Hospital, 1435 Portland Ave., Rochester, NY 14621.

Respiratory Syncytial and Other Virus Infections in Persons with Chronic Cardiopulmonary Disease

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