Impact of asthma status on the risk of respiratory syncytial virus acute respiratory infection

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Background: Respiratory syncytial virus acute respiratory infections (RSV-ARI) cause substantial morbidity to children, older adults, and adults with certain chronic conditions. The impact of asthma on risk of RSV-ARI in non-elderly adults (<65 yo) is unclear. Objective: To assess the impact of asthma on risks of medically-attended RSV-ARI and non-medically-attended RSV-ARI from October 2022 through September 2023. Methods: We included 329,751 adults aged 18-64 years receiving primary care from Mayo Clinic as a full cohort from which a randomly sampled subcohort (N=7504) participated in a prospective study that actively surveilled RSV-ARI cases in the community. We used a case-cohort design with inverse probability weights to account for differences between the cohorts. A Cox model then assessed the association between asthma and risk of medically-attended RSV-ARI. Within the subcohort, a case-control study utilized logistic regression to evaluate the association between asthma with risk of medically- and non-medically attended RSV-ARI. Results: The full cohort included 356 medically-attended RSV-ARIs, demonstrating a higher rate of RSV-ARI among adults with asthma compared to those without asthma (aHR: 1.56, 95% CI: 1.17-2.08, p=0.002). Within the subcohort, there were 118 RSV-ARI cases (medically- and non-medically-attended) and 351 matched controls without ARI. RSV-ARI cases were more likely to have asthma than controls (aOR: 1.77, 95%CI: 1.06-2.95, p=0.028). Conclusion: Adults under 65 with asthma have increased risk of both medically- and non-medically-attended RSV-ARI. RSV vaccination guidelines should acknowledge non-elderly adults with asthma as a high-risk group for RSV-ARI.

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