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Respiratory virus transmission dynamics determine timing of asthma exacerbation peaks: Evidence from a population-level model.

ABSTRACT: Asthma exacerbations exhibit a consistent annual pattern, closely mirroring the school calendar. Although respiratory viruses--the "common cold" viruses--are implicated as a principal cause, there is little evidence to link viral prevalence to seasonal differences in risk. We jointly fit a common cold transmission model and a model of biological and environmental exacerbation triggers to estimate effects on hospitalization risk. Asthma hospitalization rate, influenza prevalence, and air quality measures are available, but common cold circulation is not; therefore, we generate estimates of viral prevalence using a transmission model. Our deterministic multivirus transmission model includes transmission rates that vary when school is closed. We jointly fit the two models to 7 y of daily asthma hospitalizations in adults and children (66,000 events) in eight metropolitan areas. For children, we find that daily viral prevalence is the strongest predictor of asthma hospitalizations, with transmission reduced by 45% (95% credible interval =41-49%) during school closures. We detect a transient period of nonspecific immunity between infections lasting 19 (17-21) d. For adults, hospitalizations are more variable, with influenza driving wintertime peaks. Neither particulate matter nor ozone was an important predictor, perhaps because of the large geographic area of the populations. The school calendar clearly and predictably drives seasonal variation in common cold prevalence, which results in the "back-to-school" asthma exacerbation pattern seen in children and indirectly contributes to exacerbation risk in adults. This study provides a framework for anticipating the seasonal dynamics of common colds and the associated risks for asthmatics.

SUBMITTER: Eggo RM

PROVIDER: S-EPMC4776522 | biostudies-other | 2016 Feb

REPOSITORIES: biostudies-other

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Respiratory virus transmission dynamics determine timing of asthma exacerbation peaks: Evidence from a population-level model.

Eggo Rosalind M RM Scott James G JG Galvani Alison P AP Meyers Lauren Ancel LA

Proceedings of the National Academy of Sciences of the United States of America 20160208 8

Asthma exacerbations exhibit a consistent annual pattern, closely mirroring the school calendar. Although respiratory viruses--the "common cold" viruses--are implicated as a principal cause, there is little evidence to link viral prevalence to seasonal differences in risk. We jointly fit a common cold transmission model and a model of biological and environmental exacerbation triggers to estimate effects on hospitalization risk. Asthma hospitalization rate, influenza prevalence, and air quality ...[more]

PMID: 26858436

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Project description:ObjectivesAsthma exacerbation, associated with many risks factors, can reflect management failure. However, little is known about how risk factors are associated with exacerbation, according to asthma severity. We aimed to investigate differences in risk factors in patients with different asthma severity and evaluate whether risk factors differed between frequent exacerbators and patients with single exacerbation.DesignNationwide population-based observational study.SettingKorean National Sample Cohort database.ParticipantsWe included 22?130 adults with asthma diagnoses more than twice (ICD-10 (International Classification of Diseases, Tenth revision) codes J45 and J46) and one prescription for asthma medication from 2010 to 2011.Outcome measuresAsthma exacerbation was defined as having a corticosteroid (CS) burst characterised by a prescription of high-dose oral CS for ?3 days or one systemic CS injection, hospitalisation or emergency department visit.ResultsAmong severities, history of CS bursts was significantly associated with exacerbation. In mild and moderate asthma, exacerbation was significantly associated with age ?45 years, being female, gastro-oesophageal reflux disease and chronic rhinitis. High medication possession ratio (MPR?50%), compared with low MPR (<20%) showed adjusted ORs of 0.828 (95% CI 0.707 to 0.971) and 0.362 (0.185 to 0.708) in moderate and severe asthma, respectively. In severe asthma, compared with mild asthma, only allergic rhinitis and history of hospitalisation were strongly associated with exacerbation. When comparing frequent exacerbators to patients with single exacerbation, age ?45 years, atopic dermatitis, anxiety and history of CS burst were significant risk factors in mild and moderate asthma, whereas no risk factors were significant in severe asthma.ConclusionsDifferent associations between risk factors and asthma exacerbations based on asthma severity suggest that patients with mild asthma require greater attention to their age and comorbidities, whereas those with severe asthma require greater attention to hospitalisation history and drug adherence.

Dataset Information

Respiratory virus transmission dynamics determine timing of asthma exacerbation peaks: Evidence from a population-level model.

Publications

Respiratory virus transmission dynamics determine timing of asthma exacerbation peaks: Evidence from a population-level model.

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