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The relationship between upper respiratory infections and hospital admissions for asthma: a time-trend analysis

The relationship between upper respiratory infections and hospital admissions for asthma: a time-trend analysis
The relationship between upper respiratory infections and hospital admissions for asthma: a time-trend analysis
We have shown that viruses are associated with 80 to 85% of asthma exacerbations in school-age children in the community. We hypothesize that viral infections are also associated with severe attacks of asthma precipitating hospital admissions. To investigate this, we conducted a time-trend analysis, comparing the seasonal patterns of respiratory infections and hospital admissions for asthma in adults and children. During a 1-yr study in the Southampton area of the United Kingdom, 108 school-age children monitored upper and lower respiratory symptoms and took peak expiratory flow rate (PEFR) recordings. From children reporting a symptomatic episode or a decrease in PEFR, samples were taken for detection of viruses and atypical bacteria. A total of 232 respiratory viruses and four atypical bacteria were detected. The half-monthly rates of upper respiratory infection were compared with the half-monthly rates for hospital admissions for asthma (International Classification of Diseases [ICD] code 493) for the same time period for the hospitals serving the areas from which the cohort of schoolchildren was drawn. The relationships of upper respiratory infections and hospital admissions for asthma with school attendance were studied. Strong correlations were found between the seasonal patterns of upper respiratory infections and hospital admissions for asthma (r = 0.72; p < 0.0001). This relationship was stronger for pediatric (r = 0.68; p < 0.0001) than for adult admissions (r = 0.53; p < 0.01). Upper respiratory infections and admissions for asthma were more frequent during periods of school attendance (87% of pediatric and 84% of total admissions), than during school holiday periods (p < 0.001). These relationships remained significant when allowance was made for linear trend and seasonal variation using multiple regression analysis (p < 0.01). Not surprisingly, school attendance, because it is a major factor in respiratory virus transmission, was found to be a major confounding variable in children. This study demonstrates that upper respiratory viral infections are strongly associated in time with hospital admissions for asthma in children and adults. Rhinoviruses were the major pathogen implicated, and the majority of viral infections and asthma admissions occurred during school attendance.
1073-449X
654-660
Johnston, Sebastian L.
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Pattemore, Philip K.
ccea4411-bfb1-426f-9b53-9948e9863d65
Sanderson, Gwendolyn
300fa806-66ba-4481-8614-a77eec25d69e
Smith, Sandra
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Campbell, Michael J.
8636f189-1c81-4dc3-873e-d967d8b0ef67
Josephs, Lynn K.
865f1878-f0ca-42c3-a030-df6dcbc705b0
Cunningham, Adam
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Robinson, B. Stephen
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Myint, Steven H.
879efc17-9623-471f-a709-b427e1fabc27
Ward, Michael E.
549d4ddc-4e70-4059-809d-dfe5d497348c
Tyrrell, David A.J.
ee6ab65f-d24b-4b8f-8bc8-35c911b62a7d
Johnston, Sebastian L.
2e7c17a9-6796-436e-8772-1fe6d2ac5edc
Pattemore, Philip K.
ccea4411-bfb1-426f-9b53-9948e9863d65
Sanderson, Gwendolyn
300fa806-66ba-4481-8614-a77eec25d69e
Smith, Sandra
4cb052d0-306e-42be-8e60-86cda691e1bb
Campbell, Michael J.
8636f189-1c81-4dc3-873e-d967d8b0ef67
Josephs, Lynn K.
865f1878-f0ca-42c3-a030-df6dcbc705b0
Cunningham, Adam
9e3fa53b-4522-4c2e-a2c3-05abc6ad0e70
Robinson, B. Stephen
3f0e7148-c82d-4713-9630-ad8f5cf41c1e
Myint, Steven H.
879efc17-9623-471f-a709-b427e1fabc27
Ward, Michael E.
549d4ddc-4e70-4059-809d-dfe5d497348c
Tyrrell, David A.J.
ee6ab65f-d24b-4b8f-8bc8-35c911b62a7d

Johnston, Sebastian L., Pattemore, Philip K., Sanderson, Gwendolyn, Smith, Sandra, Campbell, Michael J., Josephs, Lynn K., Cunningham, Adam, Robinson, B. Stephen, Myint, Steven H., Ward, Michael E. and Tyrrell, David A.J. (1996) The relationship between upper respiratory infections and hospital admissions for asthma: a time-trend analysis. American Journal of Respiratory and Critical Care Medicine, 154 (3), part 1, 654-660. (doi:10.1164/ajrccm.154.3.8810601). (PMID:8810601)

Record type: Article

Abstract

We have shown that viruses are associated with 80 to 85% of asthma exacerbations in school-age children in the community. We hypothesize that viral infections are also associated with severe attacks of asthma precipitating hospital admissions. To investigate this, we conducted a time-trend analysis, comparing the seasonal patterns of respiratory infections and hospital admissions for asthma in adults and children. During a 1-yr study in the Southampton area of the United Kingdom, 108 school-age children monitored upper and lower respiratory symptoms and took peak expiratory flow rate (PEFR) recordings. From children reporting a symptomatic episode or a decrease in PEFR, samples were taken for detection of viruses and atypical bacteria. A total of 232 respiratory viruses and four atypical bacteria were detected. The half-monthly rates of upper respiratory infection were compared with the half-monthly rates for hospital admissions for asthma (International Classification of Diseases [ICD] code 493) for the same time period for the hospitals serving the areas from which the cohort of schoolchildren was drawn. The relationships of upper respiratory infections and hospital admissions for asthma with school attendance were studied. Strong correlations were found between the seasonal patterns of upper respiratory infections and hospital admissions for asthma (r = 0.72; p < 0.0001). This relationship was stronger for pediatric (r = 0.68; p < 0.0001) than for adult admissions (r = 0.53; p < 0.01). Upper respiratory infections and admissions for asthma were more frequent during periods of school attendance (87% of pediatric and 84% of total admissions), than during school holiday periods (p < 0.001). These relationships remained significant when allowance was made for linear trend and seasonal variation using multiple regression analysis (p < 0.01). Not surprisingly, school attendance, because it is a major factor in respiratory virus transmission, was found to be a major confounding variable in children. This study demonstrates that upper respiratory viral infections are strongly associated in time with hospital admissions for asthma in children and adults. Rhinoviruses were the major pathogen implicated, and the majority of viral infections and asthma admissions occurred during school attendance.

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Published date: September 1996
Organisations: Primary Care & Population Sciences, Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 362241
URI: https://eprints.soton.ac.uk/id/eprint/362241
ISSN: 1073-449X
PURE UUID: 3a061530-f078-46d4-a692-d586b2e8e567

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Date deposited: 19 Feb 2014 10:37
Last modified: 16 Jul 2019 21:12

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Contributors

Author: Philip K. Pattemore
Author: Gwendolyn Sanderson
Author: Sandra Smith
Author: Michael J. Campbell
Author: Lynn K. Josephs
Author: Adam Cunningham
Author: B. Stephen Robinson
Author: Steven H. Myint
Author: Michael E. Ward
Author: David A.J. Tyrrell

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