Prevalence of respiratory viruses in stable and acute asthma: a systematic review and meta-analysis
Clinical Snapshot
PICO Framework
| P — Population | Children and adults with stable or acute asthma |
| I — Intervention | Molecular testing for respiratory viruses |
| C — Comparator | Not applicable (prevalence study) |
| O — Outcomes | Prevalence of respiratory viruses, stratified by age group, asthma severity, and specific viral types |
Bottom Line
This comprehensive meta-analysis of 111 studies provides moderate-certainty evidence that respiratory viruses are highly prevalent in asthma patients, particularly during acute episodes. Viral detection rates nearly double during exacerbations (58.8% vs 33.9% in children), with rhinovirus being the predominant pathogen. However, the high baseline viral prevalence in stable asthma (23-34%) challenges the diagnostic utility of positive viral tests during acute episodes. Clinicians should interpret viral testing results cautiously, as a positive result may not necessarily indicate the virus is causing the current exacerbation. The findings suggest that complementary biomarkers may be needed to distinguish between viral colonisation and active infection. Age-specific viral patterns (RSV in young children, influenza in adults) may inform targeted prevention strategies. This evidence supports current guidelines emphasising symptom-based management rather than relying solely on viral testing for acute asthma treatment decisions.
Key Findings
P Value: Not reported in abstract
Effect Size: Stable asthma: 33.9% (children), 23.0% (adults); Acute asthma: 58.8% (children), 49.9% (adults)
Primary Outcome: Pooled prevalence of any respiratory virus in asthma patients
Nnt Or Sensitivity: Rhinovirus most common (45.0% in children with acute asthma vs 21.2% in adults)
Confidence Interval: 95% CIs provided for all estimates with moderate certainty evidence
Clinical Application
Molecular viral testing widely available in Australian laboratories, though cost considerations apply Relevant to Australian practice where viral-induced asthma exacerbations are common. May inform PBS funding decisions for antiviral therapies and guide RACGP asthma management protocols Children and adults with diagnosed asthma in both stable and acute phases
Abstract
BACKGROUND: Respiratory viruses, frequently detected in asthma, are associated with worse outcomes. This meta-analysis systematically quantifies the prevalence of respiratory viruses in stable and acute asthma, across children and adults, and explores factors associated with increased viral burden through meta-regression. METHODS: This prospectively registered meta-analysis (PROSPERO-CRD42023375108) included studies employing molecular techniques to assess respiratory virus prevalence in asthma. Three databases were searched in August 2024. Risk of bias and certainty of evidence were assessed. We performed random-effects meta-analysis of proportions. RESULTS: We included 111 eligible studies. Moderate-certainty evidence indicated a pooled prevalence of any respiratory virus of 33.9% (95% confidence interval 24.8-43.7%) in children and 23.0% (12.9-35.0%) in adults with stable asthma. In acute asthma, prevalence increased to 58.8% (52.5-65.0%) in children and 49.9% (41.2-58.5%) in adults (moderate certainty). Rhinovirus was the most frequently identified virus, especially in acute asthma (45.0% in children versus 21.2% in adults). Respiratory syncytial virus and bocavirus were more common in younger children, while coronavirus and influenza were more frequently detected in adults; respiratory syncytial virus peaked in older adults too. A higher prevalence of influenza virus B and adenovirus in children, and of influenza virus A and parainfluenza 2 in adults with severe versus non-severe acute asthma suggests a potential association with more severe acute attacks. CONCLUSION: Respiratory viruses are common in both stable and acute asthma. This suggests that the diagnostic value of a positive viral test during acute episodes may be limited and could benefit from complementary biomarkers to improve interpretation.
References
- 1.Ananth, S., Alimani, G. S., Boccabella, C., Khaleva, E., Hansel, J., Wang, R., Roberts, G., Kosmidis, C., Bossios, A., Vestbo, J., Papageorgiou, E., Papadopoulos, N. G., Beloukas, A., & Mathioudakis, A. G. (2026). Prevalence of respiratory viruses in stable and acute asthma: a systematic review and meta-analysis. European Respiratory Review, 35(160). https://doi.org/10.1183/16000617.0179-2025
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