Chronic Obstructive Pulmonary Disease (COPD) is an increasing global problem, often with devastating consequences for those affected, their families and communities. Respiratory Syncytial Virus (RSV) is a common respiratory pathogen, increasingly recognised as a scourge not only of children but also of frail older adults. The aim of my work was to investigate the role of RSV in exacerbations of COPD in a well-characterised cohort of patients. I also investigated the severity of RSV associated exacerbations as compared to other exacerbation causes. One hundred and seventy-seven patients were recruited into the study at the Imperial site and followed for an average of 748 days, giving a total of 296.8 patient-years of data. Virus associated exacerbations were detected by PCR analysis of nasopharyngeal swabs and sputum, and by serological investigations. A novel pentaplex RSV antibody test was used for the first time in a clinical study of this kind. RSV infection was identified in 32 exacerbations, 7.4% of the total. Thirty of these RSV-associated exacerbations were detected using the new serological method; 3 were discovered by PCR of 175 nasopharyngeal specimens and 5 by PCR of 93 sputum samples taken at exacerbation. In total, only 2 additional RSV-associated exacerbations were found by PCR, calling into question the validity and justification for the direct viral detection in studies of this kind. 26 attended exacerbations were identified as being Rhinovirus related, 9 flu related, 18 RSV related, 24 bacterial related, 16 related to other viruses and 15 having both viruses and bacteria present. 64 attended exacerbations were without any viruses or bacteria detected. When investigating the exacerbation severity, RSV associated exacerbations had a higher trend to CRP and CAT score change, but a shorter duration of illness, of 10.3 days. The duration of illness difference was statistically significant to all other exacerbation causes (10.3 vs 20.48 p=<0.05 using Dunn’s test).

In conclusion, RSV is a significant cause of COPD exacerbations. The introduction of a safe and effective RSV vaccines will, it is hoped, soon show the benefits of preventing RSV disease in vulnerable older adults with chronic respiratory disease.