Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease

The effects of respiratory viral infection on the time course of chronic ob structive pulmonary disease (COPD) exacerbation were examined by monitoring changes in systemic inflammatory markers in stable COPD and at exacerbatio n. Eighty-three patients with COPD (mean [SD] age, 66.6 [7.1] yr, FEV1, 1.0 6 [0.61] L) recorded daily peak expiratory flow rate and any increases in r espiratory symptoms. Nasal samples and blood were taken for respiratory vir us detection by culture, polymerase chain reaction, and serology, and plasm a fibrinogen and serum interleukin-6 (IL-6) were determined at stable basel ine and exacerbation. Sixty-four percent of exacerbations were associated w ith a cold occurring up to 18 d before exacerbation. Seventy-seven viruses (39 [58.2%] rhinoviruses) were detected in 66 (39.2%) of 168 COPD exacerbat ions in 53 (64%) patients. Viral exacerbations were associated with frequen t exacerbators, colds with increased dyspnea, a higher total symptom count at presentation, a longer median symptom recovery period of 13 d, and a ten dency toward higher plasma fibrinogen and serum IL-6 levels. Non-respirator y syncytial virus (RSV) respiratory viruses were detected in 11 (16%), and RSV in 16 (23.5%), of 68 stable COPD patients, with RSV detection associate d with higher Inflammatory marker levels. Respiratory virus infections are associated with more severe and frequent exacerbations, and may cause chron ic infection in COPD. Prevention and early treatment of viral infections ma y lead to a decreased exacerbation frequency and morbidity associated with COPD.