Prevalence of viral respiratory infections amongst asthmatics: Results of a meta-regression analysis

Viral respiratory infections (VRI) can act as triggers for acute asthma exacerbations and contribute significantly to asthma-related healthcare costs. Knowing the patterns of viruses amongst asthmatics can be useful in treating and preventing these exacerbations and help decrease the burden they impose on patients and healthcare systems. We aimed to quantify the viral prevalence in asthmatics presenting with exacerbations and identify influencing factors. A meta-analysis with a systematic search was conducted. Random-effect analysis was performed to quantify prevalence of viruses. A meta-regression was conducted to explain sources of heterogeneity and identify confounding factors. A VRI was detected in 52%–65% of the cases, and the detection rate was higher in children compared to adults. Rhinovirus was most often detected [51–71%], followed by respiratory syncytial virus [8–18%], influenza virus [7–15%], human parainfluenza virus [4–11%] and metapneumovirus virus [3–9%]. Meta-regression showed that the variables age and hemisphere contributed to the heterogeneity observed and were significantly associated with the detection of viruses in asthmatics. The climate variable reached significance for RSV and indicated a higher detection rate of viruses in asthmatics living in temperate compared to tropical regions. Besides age, geographic location and related variables significantly influence to what extent respiratory viruses are detected amongst asthmatics with exacerbations. Our results indicate that health authorities should adopt region- and population specific prevention and treatment strategies. Prevention and detection of viral respiratory infections in asthmatics could reduce asthma related disease burden and decrease antibiotic misuse. •52%–65% of asthmatics with exacerbations reveal an underlying viral infection.•Viruses induce asthma exacerbations more often in children compared to adults.•Lower proportion of virus-induced exacerbation in the Northern hemisphere.•Rhinovirus is the most frequently found virus amongst exacerbating asthmatics.•RSV and hMPV-induced exacerbations more common in temperate climates.