Researchers identified optimal assessment tools for RSV, influenza, and hMPV that accurately supplement the identification of well-being and disease burden.
“Clinical presentation is similar for influenza, RSV, and [human metapneumovirus (hMPV)] infections, including in those at greatest risk for progression to severe disease (older adults [≥65 years], people that are immunocompromised, and those with underlying comorbidities, including asthma, COPD, cardiovascular disease, and diabetes),” Edward E. Walsh, MD, and colleagues wrote. “The best tools to assess respiratory illness severity in adults have not been defined.”
According to the researchers, clinicians generally assess these patients using outcomes such as hypoxia, intensive care use, and length of stay. Further, they noted that correlations between clinician-rated disease severity, patient-reported outcomes (PROs) on symptom severity, and HRQOL could be helpful in indicating which tools provide the most accurate measures of patient well-being and the true burden of respiratory illness.
Dr. Walsh and colleagues developed a subanalysis of data drawn from the Hospitalized Acute Respiratory Tract Infection (HARTI) study to find if there is a correlation between clinical severity scores (CSS) and PROs in the assessment of patients with respiratory illnesses. This subanalysis aimed to gather insights and identify which assessment tools most accurately supplemented the identification of a patient’s well-being and the burden of disease. The study focused on influenza, respiratory syncytial virus (RSV), and human metapneumovirus (hMPV) as the respiratory illnesses of interest.
“Now that we have effective flu and RSV vaccines, it is logical to move forward with other important but less common viral pathogens,” Dr. Walsh tells Physician’s Weekly. “This paper compares these two viruses to the metapneumovirus and shows that they are a close third in prevalence and severity of illness. This supports efforts to design vaccines that will prevent it.”
The findings were published in Influenza and Other Respiratory Viruses.
RSV & hMPV Associated With Greater Symptom Severity
The researchers identified 3,861 patients for inclusion in the subanalysis study. Of these, 635 were diagnosed with influenza, 248 with RSV, 107 with hMPV, and 2,446 tested negative for these three respiratory illnesses. The authors gathered CSS upon the patient’s admittance to the hospital and subsequently revisited it twice during the hospital stay. In addition, PROs were obtained by the Respiratory Infection Intensity and Impact QuestionnaireTM (RiiQTM) and the EuroQol 5 Dimension 5 Level (EQ-5D-5L), administered twice during the hospital stay.
The results from this subanalysis of HARTI showed that among the hospitalized patients included in the study, RSV and hMPV showed greater symptom severity than influenza. Dyspnea, rales/rhonchi, wheezing, and shortness of breath scores trended higher for RSV and hMPV than influenza. RiiQ™ scores for cough, fatigue, and shortness of breath strongly correlated with corresponding clinician-rated symptoms.
These findings indicate that RSV, hMPV, and influenza “are clinically indistinguishable and cause similar long-term outcomes,” Dr. Walsh says.
In addition, the researchers observed a correlation between traditional CSS and the PRO tools. This finding supports using RiiQTM and the EQ-5D-5L to develop a more comprehensive assessment of well-being and symptom severity in patients with respiratory illness, according to the study results.
Implications for Clinical Practice
The findings indicate that using PROs in addition to clinicians’ assessments can “gauge patient well-being and aid patient management by accurately assessing respiratory illness severity due to RSV, hMPV, or influenza,” Dr. Walsh and colleagues wrote.
Also, regarding RSV, “it needs to be recognized that it is a common and serious illness, especially in people with heart and lung diseases, and this is even more of a problem in patients aged from 70 onward,” Dr. Walsh says.
“In medical practice, if doctors recognize that a patient has one of these viruses, antibiotics can often be shortened or even avoided,” he continues. “But since you can’t distinguish them clinically, specific diagnostic tests like PCR are necessary.”
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