What viruses cause cold exacerbation, particularly in individuals with pre-existing respiratory conditions like asthma or Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

Respiratory viral infections, particularly rhinoviruses, influenza viruses, respiratory syncytial virus (RSV), coronaviruses, human metapneumovirus, parainfluenza viruses, and adenoviruses, are the primary triggers for cold exacerbation in individuals with pre-existing respiratory conditions like asthma or Chronic Obstructive Pulmonary Disease (COPD). These viruses can replicate more efficiently in the airways of individuals with respiratory conditions due to impaired antiviral immune responses, leading to increased mucus production, bronchial hyperresponsiveness, and airway narrowing 1.

Key Viruses Involved

• Rhinoviruses: account for approximately 60% of virus-induced exacerbations
• Influenza viruses
• Respiratory syncytial virus (RSV)
• Coronaviruses
• Human metapneumovirus
• Parainfluenza viruses
• Adenoviruses

Impact on Asthma and COPD Patients

In asthma patients, viral infections can shift the immune response toward a Th2-dominant pattern, exacerbating allergic inflammation. For COPD patients, viruses can amplify existing neutrophilic inflammation and oxidative stress 1.

Prevention and Treatment Strategies

Prevention strategies include:

• Annual influenza vaccination
• Pneumococcal vaccination
• Proper hand hygiene
• Maintenance of controller medications

During exacerbations, treatment typically involves:

• Increased bronchodilator use
• Short courses of oral corticosteroids (such as prednisone 40mg daily for 5 days)
• Antibiotics if bacterial infection is suspected 1.

Early intervention at the first sign of viral symptoms can help minimize the severity of exacerbations in these vulnerable populations.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Viruses Causing Cold Exacerbation

• Rhinoviruses and coronaviruses are known to cause the majority of common colds and play a part in more serious respiratory illnesses, including exacerbations in individuals with pre-existing respiratory conditions like asthma or Chronic Obstructive Pulmonary Disease (COPD) 2.
• Respiratory viruses, including influenza A/H3N2 and rhinoviruses, are important contributors to acute exacerbations of chronic obstructive pulmonary disease (AECOPD) 3.
• Rhinoviruses trigger a chemokine response upon infection, which may lead to exacerbation of symptoms such as asthma and inflammation 4.
• Similar pathogens, including human rhinovirus, respiratory syncytial virus, influenza virus, parainfluenza virus, and coronavirus, are frequently detected during exacerbation of asthma and/or COPD 5.

Specific Viruses Involved

• Rhinoviruses, coronaviruses OC43 and 229E, influenza B, respiratory syncytial virus, and parainfluenza virus are associated with objective evidence of an exacerbation of asthma 6.
• Infections with these viruses can cause or are associated with exacerbations of asthma in adults, leading to reductions in peak flow rate and worsening of symptoms 6.
• Human metapneumovirus (hMPV), adenovirus, and bocavirus are also detected in patients with AECOPD, although their role in exacerbations may vary 3.

Clinical Significance

• Recognizing and understanding the clinical features of patients with COPD and/or asthma associated with respiratory viral infections is crucial for effective management and treatment 5.
• Laboratory confirmation of respiratory tract infections can help identify the causative virus and guide antiviral therapy, reducing the risk of inappropriate antibiotic use 3.
• Preventive strategies, such as influenza vaccination, can also be employed to reduce the risk of exacerbations in individuals with pre-existing respiratory conditions 3.