What interventions are recommended for an elderly patient with Respiratory Syncytial Virus (RSV) infection who is currently taking anastrozole (Arimidex)?

Management of RSV Infection in an Elderly Patient on Anastrozole

For an elderly patient with active RSV infection currently taking anastrozole, provide aggressive supportive care as the primary intervention, continue the anastrozole without interruption, and ensure RSV vaccination once the acute infection resolves to prevent future episodes. 1

Immediate Management: Supportive Care

The cornerstone of RSV treatment in elderly adults is supportive care, as there are no FDA-approved antiviral treatments for RSV in adults. 1 This approach should include:

• Oxygen therapy to maintain adequate oxygen saturation, which is critical given the patient's age and potential for respiratory compromise 2
• Hydration support and monitoring for signs of respiratory deterioration 2
• Bronchodilators if the patient develops bronchospasm or has underlying reactive airway disease 2
• Close monitoring for progression to lower respiratory tract disease, as elderly patients face mortality rates of 4.6-6.1% when hospitalized with RSV 1

Anastrozole Continuation

Continue anastrozole without interruption during the acute RSV infection. There is no evidence that anastrozole increases RSV severity or interferes with recovery. The provided evidence does not identify aromatase inhibitors as immunosuppressive agents that would warrant special consideration for RSV management. 3, 4

The key immunosuppressive risk factors identified for severe RSV include corticosteroids, solid organ transplant, hematopoietic stem cell transplant, and other immunosuppressive medications—none of which apply to anastrozole. 1

When to Consider Hospitalization

Hospitalization should be considered if the patient develops: 2

• Respiratory distress or increased work of breathing
• Hypoxemia despite supplemental oxygen
• Significant comorbidities such as heart disease, diabetes, chronic kidney disease, or COPD that increase risk for severe outcomes 3, 2

Antiviral Therapy Considerations

Ribavirin is NOT recommended for this patient. While ribavirin (aerosolized, oral, or intravenous) has been used off-label in severely immunocompromised adults with RSV, it is reserved for patients with solid organ transplants, hematopoietic stem cell transplants, or severe immunosuppression—not for elderly patients on anastrozole. 1, 5, 6 The evidence for ribavirin remains limited to observational studies, and it is not FDA-approved for RSV in adults. 1

Diagnostic Confirmation

If not already done, confirm RSV diagnosis with nucleic acid-based testing (RT-PCR), as this is the most sensitive and specific method for elderly patients. 1, 2 Viral culture and antigen detection are insensitive in adults due to lower viral loads. 6

Prevention for Future Episodes

Once the acute infection resolves, strongly recommend RSV vaccination. 1, 2 The patient should receive:

• A single lifetime dose of RSV vaccine (either RSVPreF3/Arexvy or RSVpreF/Abrysvo) 4, 1
• Optimal timing is late summer or early fall (August-October), just before RSV season 3, 4
• All adults ≥75 years should receive RSV vaccination regardless of comorbidities 4, 1
• Adults aged 60-74 years should receive vaccination if they have any chronic medical conditions or risk factors 4, 1

Previous RSV infection does not confer long-lasting immunity, making vaccination essential even after recovery. 4, 1

Follow-up Care

• Schedule follow-up evaluation after recovery to assess for persistent symptoms or functional decline, as RSV can cause significant functional deterioration in elderly patients 1, 2
• Reassess overall health status and optimize management of any underlying conditions 2
• Ensure RSV vaccination is administered before the next respiratory virus season if not previously vaccinated 2

Critical Pitfall to Avoid

Do not discontinue anastrozole based on the RSV infection. The cancer treatment should continue uninterrupted unless there are specific oncologic reasons to hold it. The RSV infection itself is not an indication to stop aromatase inhibitor therapy, as anastrozole does not cause clinically significant immunosuppression that would complicate RSV management. 3, 4