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Acute exacerbation of chronic obstructive pulmonary disease hospitalizations by month, Kashmir, India, October 2010-September 2012.
Source publication
We estimate the contribution of influenza to hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in Kashmir, India. Prospective surveillance for influenza among patients hospitalized with AECOPD was conducted at a tertiary care hospital. Patients had clinical data collected and nasal/throat swabs tested for in...
Citations
... 2,3 Influenza infection among hospitalized patients with COPD is associated with high rates of mortality (10%) and critical illness (17%) compared with influenza-negative patients, but it is unclear if other seasonal respiratory viruses are associated with equally poor prognoses. 5,6 Studies evaluating the impact of non-influenza respiratory viruses (NIRVs) among patients with COPD are limited by small sample sizes (<150 patients), examination of limited viral seasons, mixed cohorts of hospitalized and outpatients, and viral testing techniques with variable accuracy. [7][8][9][10][11] There are no large prospective studies in North America which determine the prevalence and impact of seasonal respiratory viral infections among real-world hospitalized patients with COPD. ...
Background:
Seasonal respiratory viral infections are associated with exacerbations and morbidity among patients with COPD. The real-world clinical outcomes associated with seasonal viral infections are less well established among hospitalized patients.
Research question:
To estimate the association between seasonal respiratory viral infections, 30-day mortality, and intensive care unit (ICU) admission among hospitalized COPD patients.
Study design and methods:
We conducted an analysis of a national prospective multicenter cohort of COPD patients hospitalized with acute respiratory illness during winter seasons (2011-2015) in Canada. Nasopharyngeal swabs were performed on all patients at the onset of hospital admission for diagnosis of viral infection. Primary outcomes were 30-day mortality and ICU admissions. Secondary outcomes included invasive/non-invasive ventilation use.
Results:
Among 3931 hospitalized patients with COPD, 28.5% (1122/3931) were diagnosed with seasonal respiratory viral infection. Viral infection was associated with increased admission to ICU (OR 1.5, 95% CI 1.2-1.9) and need for mechanical ventilation (OR 1.9, 95% CI 1.4-2.5), but was not associated with mortality (OR 1.1, 95% CI 0.8-1.4). Patients with respiratory syncytial virus (RSV) were equally likely to require ICU admission (OR 1.09, 95% CI 0.67-1.78), and more likely to need non-invasive ventilation (OR 3.1; 95% CI 1.8-5.1) compared to patients with influenza.
Interpretation:
Our results suggest COPD patients requiring hospitalization for respiratory symptoms should routinely receive viral testing at admission, especially for RSV and influenza, to inform prognosis, clinical management, and infection control practices during winter seasons. Patients with COPD will be an important target population for newly developed RSV therapeutics.
Clinical trial registration:
ClinicalTrials.gov ID: NCT01517191.
... Twin nasopharyngeal/oropharyngeal swabs were collected from the (2) patients . Nasopharyngeal sample was obtained from one nostril while an oropharyngeal swab was obtained from both sides of throat using a sterile, exible, thin, ocked swab. ...
... The recruited patients included 59 male and 11 female. A study (2) done by Parvaiz A Koul et al reported that out of the 233 recruited patients, 152 were male and 81 were female patients with age ranging (8) from 40 to 100 (median 65) years. McManus TE et al found no associations were seen between viral infection and patient sex or medication. ...
BACKGROUND: Acute exacerbation of COPD (AECOPD) is one of the most common cause of hospital admission. It causes signicant morbidity, mortality and inexorable decline in ling function. Many exacerbations are believed to be due to upper and/ lower respiratory tract viral infections, but the incidence of these infections in patients with COPD is still undetermined. Objectives of the study are-(a) To nd out the viral etiology in patients having acute exacerbation of COPD. (b) To correlate the severity of COPD patients having exacerbations with viral etiology. METHODS: This cross-sectional study was carried out on 70 AECOPD patients admitted in department of Respiratory Medicine, Institute of Respiratory Diseases, SMS Medical College, Jaipur during July 2019–June 2020. Demographic and clinical parameters were recorded from each patient during admission. Twin nasopharyngeal/oropharyngeal swabs were collected and are tested for Respiratory viruses via RT-PCR. RESULTS: Respiratory viruses were detected in 15 of 70 (21.42%) patients during exacerbations of COPD. The viruses detected were inuenza (10%), rhinovirus (5.71%), adenovirus (4.29%) and RSV (1.42%). Majority of the patients had exacerbations in severe COPD subgroup, had duration of hospital stay of more than or equal to 5 days, had one episode of acute exacerbation per year and 5, 9, 11 respiratory viruses were detected in this group respectively. CONCLUSION: Viral infections seem to contribute to the exacerbations of COPD in our settings and should be strongly considered in the management of such patients. Considering appropriate antiviral therapy can timely reduce morbidity in an event of an inuenza viral exacerbation.
... [6][7][8][9] The emergence of a new clade of influenza A/H1N1 virus (A/Michigan) was documented in the country in 2015 that largely replaced the California strain of A/H1N1, the agent responsible for the 2009 pandemic. [9] Influenza virus has been implicated in the causation of virus pneumonias, [10] CAP, [11] and acute exacerbation of chronic respiratory disease in India, [12,13] at a huge cost to the exchequer. [14] Against this backdrop, an effective vaccination against influenza is a very attractive mode of protection against various influenza-related illnesses. ...
... However, studies directly comparing the rates of asthma and COPD exacerbations in patients with influenza A and B have been limited. A study by Koul et al. saw similar rates of COPD exacerbations between influenza A (H1N1) (31%), influenza A (H3N2) (44%) and Influenza B (26%) patients [98]. However, the patient sample size was small and the statistical difference between them was not mentioned. ...
Severe influenza infection represents a leading cause of global morbidity and mortality. Several clinical syndromes that involve a number of organs may be associated with Influenza infection. However, lower respiratory complications remain the most common and serious sequel of influenza infection. These include influenza pneumonia, superinfection with bacteria and fungi, exacerbation of underlying lung disease and ARDS. This review analyzes the available literature on the epidemiology and clinical considerations of these conditions. It also provides an overview of the effects of type of influenza, antiviral therapy, vaccination and other therapies on the outcome of these complications.
... Previous studies reported a 5% to 22% prevalence of influenza virus among patients experiencing an exacerbation. [2][3][4][5][6][7][8] International guidelines recommend annual influenza vaccination for patients with COPD to reduce influenzarelated exacerbations and acute respiratory infections. 9,10 This recommendation is based on a systematic review of six randomized studies that showed a reduction in exacerbations following influenza vaccination, particularly in the first 4 weeks postvaccination. ...
Background:
The effectiveness of influenza vaccination in reducing influenza-related hospitalizations among patients with COPD is not well described, and influenza vaccination uptake remains suboptimal.
Methods:
Data were analyzed from a national, prospective, multicenter cohort study including patients with COPD, hospitalized with any acute respiratory illness or exacerbation between 2011 and 2015. All patients underwent nasopharyngeal swab screening with polymerase chain reaction (PCR) testing for influenza. The primary outcome was an influenza-related hospitalization. We identified influenza-positive cases and negative control subjects and used multivariable logistic regression with a standard test-negative design to estimate the vaccine effectiveness for preventing influenza-related hospitalizations.
Results:
Among 4,755 hospitalized patients with COPD, 4,198 (88.3%) patients with known vaccination status were analyzed. The adjusted analysis showed a 38% reduction in influenza-related hospitalizations in vaccinated vs unvaccinated individuals. Influenza-positive patients (n = 1,833 [38.5%]) experienced higher crude mortality (9.7% vs 7.9%; P = .047) and critical illness (17.2% vs 12.1%; P < .001) compared with influenza-negative patients. Risk factors for mortality in influenza-positive patients included age > 75 years (OR, 3.7 [95% CI, 0.4-30.3]), cardiac comorbidity (OR, 2.0 [95% CI, 1.3-3.2]), residence in long-term care (OR, 2.6 [95% CI, 1.5-4.5]), and home oxygen use (OR, 2.9 [95% CI, 1.6-5.1]).
Conclusions:
Influenza vaccination significantly reduced influenza-related hospitalization among patients with COPD. Initiatives to increase vaccination uptake and early use of antiviral agents among patients with COPD could reduce influenza-related hospitalization and critical illness and improve health-care costs in this vulnerable population.
Trial registry:
ClinicalTrials.govNo.:NCT01517191; URL www.clinicaltrials.gov.
... Pilgrimage acquired viral infections are important for public health because these do not follow the traditional seasonality of any geography. We have earlier demonstrated that influenza and non-influenza respiratory viruses contribute significantly to acute exacerbations of COPD with a high level of activity during winter months in northern India, in a pattern that resembles the northern hemispherical pattern of circulation of influenza [18][19][20] . However, since Hajj and Umrah are performed throughout the year with changing dates, the congregation of potentially infected individuals from all across the world with individual seasonality of circulation of these viruses makes the acquisition and transmission of the viruses possible. ...
... Our study highlighted the potential for persons returning from mass gatherings to facilitate transmission of respiratory pathogens and reinforced the need for better infection prevention and control measures such as vaccination, health education on cough etiquette and hand hygiene, or use of facemasks 23 . There is a need for larger studies for surveillance for the viruses among the pilgrims returning from mass religious gatherings as also international and multi-sectorial coordination and communication for effective surveillance among Hajj and Umrah pilgrims and continued evaluation of the implementation of the recommended guidance 4,18 for prevention of communicable health hazards among the pilgrims. An assessment of the burden of the viruses would also help public health and policy planners to devise appropriate public health response including infection control strategies during and after return from the pilgrimage. ...
Background & objectives: Respiratory tract infections are common among Hajj and Umrah pilgrims which pose a public health risk of spread of respiratory infections. Influenza has been reported from Indian Hajj and Umrah returning pilgrims, but data on other respiratory pathogens are sparse in India. Here we report the presence of common respiratory viral pathogens in returning Hajj and Umrah pilgrims suffering from acute respiratory illness (ARI) in 2014-2015.
... Pilgrimage acquired viral infections are important for public health because these do not follow the traditional seasonality of any geography. We have earlier demonstrated that influenza and non-influenza respiratory viruses contribute significantly to acute exacerbations of COPD with a high level of activity during winter months in northern India, in a pattern that resembles the northern hemispherical pattern of circulation of influenza [18][19][20] . However, since Hajj and Umrah are performed throughout the year with changing dates, the congregation of potentially infected individuals from all across the world with individual seasonality of circulation of these viruses makes the acquisition and transmission of the viruses possible. ...
... Our study highlighted the potential for persons returning from mass gatherings to facilitate transmission of respiratory pathogens and reinforced the need for better infection prevention and control measures such as vaccination, health education on cough etiquette and hand hygiene, or use of facemasks 23 . There is a need for larger studies for surveillance for the viruses among the pilgrims returning from mass religious gatherings as also international and multi-sectorial coordination and communication for effective surveillance among Hajj and Umrah pilgrims and continued evaluation of the implementation of the recommended guidance 4,18 for prevention of communicable health hazards among the pilgrims. An assessment of the burden of the viruses would also help public health and policy planners to devise appropriate public health response including infection control strategies during and after return from the pilgrimage. ...
Background & objectives: Respiratory tract infections are common among Hajj and Umrah pilgrims which pose a public health risk of spread of respiratory infections. Influenza has been reported from Indian Hajj and Umrah returning pilgrims, but data on other respiratory pathogens are sparse in India. Here we report the presence of common respiratory viral pathogens in returning Hajj and Umrah pilgrims suffering from acute respiratory illness (ARI) in 2014-2015.
Methods: Respiratory specimens (nasopharyngeal and throat swabs) were collected from 300 consenting pilgrims with ARI in the past one week and tested for influenza and Middle East Respiratory Syndrome coronavirus (MERS-CoV) and other respiratory viruses using in-house standardized quantitative real-time reverse-transcription polymerase chain reaction. Clinical features among the pathogen positive and negative patients were compared. The patients received symptomatic treatment and antivirals where appropriate and were followed telephonically to collect data on illness outcome.
Results: Ninety seven (32.3%) of the 300 participants were tested positive for any virus, most common being influenza viruses (n=33, 11%). Other respiratory viruses that were detected included human coronaviruses [n=26, 8.7%; OC43 (n=19, 6.3%) and C229E (n=7, 2.3%)], rhinovirus (n=20, 6%), adenoviruses (n=8, 2.6%), parainfluenza viruses (n=7, 2.3%), respiratory syncytial virus (n=3, 1%) and bocaviruses (n=2, 0.6%). Clinical features observed in pathogen positive and pathogen negative patients did not differ significantly. Eighteen influenza positive patients were treated with oseltamivir.
Interpretation & conclusions: Pilgrims returning from mass gatherings are often afflicted with respiratory pathogens with a potential to facilitate transmission of respiratory pathogens across international borders. The study reinforces the need for better infection prevention and control measures such as vaccination, health education on cough etiquette and hand hygiene.
... Although there is evidence that viral infections lead to exacerbations of chronic airway diseases such as COPD [10,11], vaccination has not been proven to reduce mortality [12]. On the other hand, a systematic review that summarized the immunogenicity, safety, efficacy, and effectiveness of influenza vaccination in patients with COPD found that six of seven studies indicated long-term benefits such as decreased number of exacerbations, reduced number of hospitalizations, and decreased rates of all-cause and respiratory mortality [13]. ...
Objectives:
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are major components of COPD-related socioeconomic burden. Upper or lower respiratory tract infections, usually caused by respiratory viruses or bacteria, are common causes of AECOPD. Vaccination aganist influenza virus and Streptoccus pneumoniae, the most prevalent agents, is recommended by COPD guidelines. The aims of this study were to determine the factors affecting vaccination among patients with COPD and to assess the effect of vaccination status on AECOPD.
Materials and methods:
Patients with COPD were recruited from the outpatient clinic of a tertiary hospital between December 2014 and January 2015. Demographic data, vaccination status, and COPD-related hospital admissions triggered by tracheobronchial infections were evaluated.
Results:
In total, 108 patients were enrolled; 102 (94%) subjects were male, and 6 (6%) subjects were female; the mean age was 65.6 years. The number of patients who had received pneumococcal and influenza vaccinations were 8 (0.07%) and 36 (33.3%), respectively. There was no significant correlation between the level of education and vaccination status. No significant difference was found between two groups in terms of exacerbation frequency, hospitalization rates, mMRC scores, and COPD stages.
Conclusion:
More efforts by both physicians and patients are needed to reach the ideal rates of vaccination for COPD.
... We have recently reported that influenza A and B viruses are associated with about 8% of COPD exacerbations. [4] Data regarding the contribution of other respiratory viruses in the causation of exacerbations of COPD are scant, especially from the developing countries. We herewith report our results of testing of patients for other respiratory viruses in patients with COPD exacerbation. ...
... Kashmir has a temperate geography in contrast with the generally more tropical climate in the rest of the country, and we have earlier reported a temperate seasonality of influenza virus circulation [5,6] which contributes to the exacerbations of COPD in 8% cases. [4] Demographic and clinical parameters were recorded in each case. Twin nasopharyngeal/oropharyngeal swabs were collected from the patients as described earlier. ...
... Twin nasopharyngeal/oropharyngeal swabs were collected from the patients as described earlier. [4] Tested for respiratory viruses including respiratory syncytial virus (RSV) A and B, parainfluenza (PIV) 1, 2, 3, [7] and 4, [8] human metapneumovirus (hMPV) A and B, [9] influenza A and B, enterovirus, corona NL65, OC43, and 229E viruses, [10] adenovirus 2 and 4, [11] rhinovirus, [10] and bocavirus, [12] were performed by in-house standardized duplex real time reverse-transcription polymerase chain reaction (qRT-PCR) using previously published primers and probes. The details of the enrollment and testing for influenza among these patients have been reported elsewhere. ...
Objective:
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) cause significant morbidity, mortality, and an inexorable decline of lung function. Data from developed countries have shown viruses to be important causes of AECOPD, but data from developing countries like India are scant. We set out to determine the contribution of viruses in the causation of hospitalized patients with AECOPD.
Methods:
Twin nasopharyngeal/oropharyngeal swabs collected from 233 patients admitted with an acute AECOPD and tested for respiratory viruses including respiratory syncytial virus A and B, parainfluenza were (PIV) 1, 2, 3, and 4, human metapneumovirus (hMPV) A and B, influenza A and B, enterovirus, corona NL65, OC43, and 229E viruses, adenovirus 2 and 4, rhinovirus, and bocavirus, by duplex real time reverse-transcription polymerase chain reaction (qRT-PCR) using CDC approved primers and probes. Samples positive for influenza A were subtyped for A/H1N1pdm09 and A/H3N2 whereas influenza B samples were subtyped into B/Yamagata and B/Victoria subtypes, using primers and probes recommended by CDC, USA.
Results:
Respiratory viruses were detected in 46 (19.7%) cases, influenza A/H3N2 and rhinoviruses being the most common viruses detected. More than one virus was isolated in four cases consisting of hMPV-B + adeno-2 + Inf-B; rhino + H3N2, PIV-1 + rhino; and PIV-1+ hMPV-B in one case each. Ancillary supportive therapeutic measures included bronchodilators, antibiotics, steroids, and ventilation (noninvasive in 42 and invasive in 4). Antiviral therapy was instituted in influenza-positive patients. Three patients with A/H3N2 infection died during hospitalization.
Conclusions:
We conclude that respiratory viruses are important contributors to AECOPD in India. Our data calls for prompt investigation during an exacerbation for viruses to obviate inappropriate antibiotic use and institute antiviral therapy in viral disease amenable to antiviral therapy. Appropriate preventive strategies like influenza vaccination also need to be employed routinely.
... 31 Pandemic and seasonal influenza viruses have been found to contribute significantly to the causation of respiratory infections including pneumonias 32 as well as infective exacerbations of COPD. 33 Infection with influenza facilitates s e c o n d a r y b a c t e r i a l i n f e c t i o n s . Influenza vaccination may help prevent CAP directly by preventing influenza pneumonia or indirectly by preventing secondary bacterial CAP. 31 Seasonal circulation of influenza viruses is linked with a surge in diagnosed influenza and pneumonia. ...
Streptococcus pneumoniae ( S .pneumoniae) is a major global pathogen that poses a risk of pneumococcal pneumonia and invasive pneumococcal disease with considerable morbidity and mortality across all ages, particularly young children and older adults, and persons with comorbidities that affect their ability to make antibodies to capsular polysaccharides. Invasive pneumococcal disease (IPD) i.e. invasion of the pathogen into normally sterile sites can cause diseases like meningitis, bacteremia, endocarditis, osteomyelitis and empyema and according to the Centers for Disease Control and Prevention(CDC), USA is responsible for an incidence of 10.6/100,000 US population, primarily in the adults.1 According to the latest global burden of disease study, pneumococcal pneumonia is the commonest cause of pneumonia and was responsible
for 1517,000 (95% uncertainly interval 958,000–2184,000) global counterfactual deaths in 2015, with
the bulk occurring in children aged < 5 years, where it was responsible for the highest attributable fraction of death due to lower respiratory infection.2 Thus, pneumococcal disease is a significant yet preventable disease burden in adults over the age of 50 years and can be fatal in this age group, especially among those with comorbid medical conditions.
