Prevalence of respiratory viruses in stable and acute asthma: a systematic review and meta-analysis
Prevalence of respiratory viruses in stable and acute asthma: a systematic review and meta-analysis
Background: respiratory viruses, frequently detected in asthma, are associated with worse outcomes. This meta-analysis systematically quantifies the prevalence of respiratory viruses in stable and acute asthma, across children and adults, and explores factors associated with increased viral burden through meta-regression.
Methods: this prospectively registered meta-analysis (PROSPERO-CRD42023375108) included studies employing molecular techniques to assess respiratory virus prevalence in asthma. Three databases were searched in August 2024. Risk of bias and certainty of evidence were assessed. We performed random-effects meta-analysis of proportions.
Results: we included 111 eligible studies. Moderate-certainty evidence indicated a pooled prevalence of any respiratory virus of 33.9% (95% confidence interval 24.8-43.7%) in children and 23.0% (12.9-35.0%) in adults with stable asthma. In acute asthma, prevalence increased to 58.8% (52.5-65.0%) in children and 49.9% (41.2-58.5%) in adults (moderate certainty). Rhinovirus was the most frequently identified virus, especially in acute asthma (45.0% in children versus 21.2% in adults). Respiratory syncytial virus and bocavirus were more common in younger children, while coronavirus and influenza were more frequently detected in adults; respiratory syncytial virus peaked in older adults too. A higher prevalence of influenza virus B and adenovirus in children, and of influenza virus A and parainfluenza 2 in adults with severe versus non-severe acute asthma suggests a potential association with more severe acute attacks.
Conclusion: respiratory viruses are common in both stable and acute asthma. This suggests that the diagnostic value of a positive viral test during acute episodes may be limited and could benefit from complementary biomarkers to improve interpretation.
Acute Disease, Adult, Asthma/epidemiology, Child, Humans, Prevalence, Respiratory Tract Infections/epidemiology, Risk Factors, Virus Diseases/epidemiology, Viruses/isolation & purification
Ananth, Sachin
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Alimani, Gioulinta S.
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Boccabella, Cristina
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Khaleva, Ekaterina
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Hansel, Jan
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Wang, Ran
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Roberts, Graham
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Kosmidis, Chris
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Bossios, Apostolos
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Vestbo, Jørgen
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Papageorgiou, Effie
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Papadopoulos, Nikolaos G.
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Beloukas, Apostolos
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Mathioudakis, Alexander G.
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Ananth, Sachin
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Alimani, Gioulinta S.
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Boccabella, Cristina
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Khaleva, Ekaterina
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Hansel, Jan
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Wang, Ran
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Roberts, Graham
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Kosmidis, Chris
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Bossios, Apostolos
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Vestbo, Jørgen
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Papageorgiou, Effie
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Papadopoulos, Nikolaos G.
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Beloukas, Apostolos
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Mathioudakis, Alexander G.
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Ananth, Sachin, Alimani, Gioulinta S., Boccabella, Cristina, Khaleva, Ekaterina, Hansel, Jan, Wang, Ran, Roberts, Graham, Kosmidis, Chris, Bossios, Apostolos, Vestbo, Jørgen, Papageorgiou, Effie, Papadopoulos, Nikolaos G., Beloukas, Apostolos and Mathioudakis, Alexander G.
(2026)
Prevalence of respiratory viruses in stable and acute asthma: a systematic review and meta-analysis.
European Respiratory Review, 35 (180), [250179].
(doi:10.1183/16000617.0179-2025).
Abstract
Background: respiratory viruses, frequently detected in asthma, are associated with worse outcomes. This meta-analysis systematically quantifies the prevalence of respiratory viruses in stable and acute asthma, across children and adults, and explores factors associated with increased viral burden through meta-regression.
Methods: this prospectively registered meta-analysis (PROSPERO-CRD42023375108) included studies employing molecular techniques to assess respiratory virus prevalence in asthma. Three databases were searched in August 2024. Risk of bias and certainty of evidence were assessed. We performed random-effects meta-analysis of proportions.
Results: we included 111 eligible studies. Moderate-certainty evidence indicated a pooled prevalence of any respiratory virus of 33.9% (95% confidence interval 24.8-43.7%) in children and 23.0% (12.9-35.0%) in adults with stable asthma. In acute asthma, prevalence increased to 58.8% (52.5-65.0%) in children and 49.9% (41.2-58.5%) in adults (moderate certainty). Rhinovirus was the most frequently identified virus, especially in acute asthma (45.0% in children versus 21.2% in adults). Respiratory syncytial virus and bocavirus were more common in younger children, while coronavirus and influenza were more frequently detected in adults; respiratory syncytial virus peaked in older adults too. A higher prevalence of influenza virus B and adenovirus in children, and of influenza virus A and parainfluenza 2 in adults with severe versus non-severe acute asthma suggests a potential association with more severe acute attacks.
Conclusion: respiratory viruses are common in both stable and acute asthma. This suggests that the diagnostic value of a positive viral test during acute episodes may be limited and could benefit from complementary biomarkers to improve interpretation.
Text
Eur Respir Rev-2026-Ananth-250179
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More information
Accepted/In Press date: 9 February 2026
e-pub ahead of print date: 8 April 2026
Keywords:
Acute Disease, Adult, Asthma/epidemiology, Child, Humans, Prevalence, Respiratory Tract Infections/epidemiology, Risk Factors, Virus Diseases/epidemiology, Viruses/isolation & purification
Identifiers
Local EPrints ID: 511658
URI: http://eprints.soton.ac.uk/id/eprint/511658
ISSN: 0905-9180
PURE UUID: d1d06bac-4a93-4342-8639-e78ddd426e38
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Date deposited: 26 May 2026 17:06
Last modified: 27 May 2026 02:00
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Contributors
Author:
Sachin Ananth
Author:
Gioulinta S. Alimani
Author:
Cristina Boccabella
Author:
Ekaterina Khaleva
Author:
Jan Hansel
Author:
Ran Wang
Author:
Chris Kosmidis
Author:
Apostolos Bossios
Author:
Jørgen Vestbo
Author:
Effie Papageorgiou
Author:
Nikolaos G. Papadopoulos
Author:
Apostolos Beloukas
Author:
Alexander G. Mathioudakis
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