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Viral etiology of acute exacerbations of chronic obstructive pulmonary disease in Hong Kong

¹Department of Medicine and Therapeutics, The Chinese University of Hong Kong ²Department of Microbiology, The Chinese University of Hong Kong

dschui{at}cuhk.edu.hk

Abstract

IntroductionViral respiratory infections may precipitate acute exacerbations of chronic obstructive pulmonary disease (AECOPD). However, little is known about viral etiology related to AECOPD in Asia. We aimed to study the viral etiology of AECOPD in Hong Kong.

MethodsPatients admitted to an acute hospital in Hong Kong with AECOPD were recruited prospectively from May 1, 2004 to April 30, 2005. Nasopharyngeal aspirates (NPA) were collected and assessed by polymerase chain reaction (PCR) and viral culture. Spirometry was performed in the stable phase at 2-3 months post hospital discharge.

Results(mean[SD]): There were 262 episodes of AECOPD among 196 patients. Their age was 75.7[7.7]yrs with 160 males. The FEV₁ was 39.6[18.9]% predicted normal and FEV₁/FVC ratio was 58.0[15.2]%. Fifty-eight episodes (22.1%) yielded positive viral PCR results. The viruses identified were influenza A (7.3%), coronavirus OC43 (4.6%), rhinovirus (3.1%), influenza B (2.7%), and respiratory syncytial virus (2.3%). The diagnostic yield of viral identification by PCR was 2.7 times higher than that based on conventional viral culture. The rates of identifying a positive viral etiology by PCR were similar among the subjects with FEV₁ 50%, 30-50% and <30% predicted normal. Viral infection appeared to have no effect on subsequent readmissions or mortality rate over a study period of 1 year

ConclusionInfluenza A and two less attended viruses, coronavirus OC43 and rhinovirus, were the common etiological agents in patients hospitalized with AECOPD in Hong Kong. These should be considered in developing diagnostic and intervening strategies pertaining to AECOPD.(Word count 246)

Key Words: CODP • acute exacerbation • viruses