{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:25:27Z","timestamp":1790256327442,"version":"4.1.0"},"reference-count":37,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,7,1]]},"abstract":"<jats:sec>\n                  <jats:title\/>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>OBJECTIVES:<\/jats:title>\n                  <jats:p>Respiratory pathogens commonly trigger pediatric asthma exacerbations, but their impact on severity and treatment response remains unclear.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>We performed a secondary analysis of the Determinants of Oral Corticosteroid Responsiveness in Wheezing Asthmatic Youth (DOORWAY) study, a prospective cohort study of children (aged 1\u201317 years) presenting to the emergency department with moderate or severe exacerbations. Nasopharyngeal specimens were analyzed by RT-PCR for 27 respiratory pathogens. We investigated the association between pathogens and both exacerbation severity (assessed with the Pediatric Respiratory Assessment Measure) and treatment failure (hospital admission, emergency department stay &amp;gt;8 hours, or relapse) of a standardized severity-specific treatment. Logistic multivariate regressions were used to estimate average marginal effects (absolute risks and risk differences [RD]).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>Of 958 participants, 61.7% were positive for \u22651 pathogen (rhinovirus was the most prevalent [29.4%]) and 16.9% experienced treatment failure. The presence of any pathogen was not associated with higher baseline severity but with a higher risk of treatment failure (20.7% vs 12.5%; RD = 8.2% [95% confidence interval: 3.3% to 13.1%]) compared to the absence of a pathogen. Nonrhinovirus pathogens were associated with an increased absolute risk (RD) of treatment failure by 13.1% (95% confidence interval: 6.4% to 19.8%), specifically, by 8.8% for respiratory syncytial virus, 24.9% for influenza, and 34.1% for parainfluenza.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>Although respiratory pathogens were not associated with higher severity on presentation, they were associated with increased treatment failure risk, particularly in the presence of respiratory syncytial virus, influenza, and parainfluenza. This supports influenza prevention in asthmatic children, consideration of pathogen identification on presentation, and exploration of treatment intensification for infected patients at higher risk of treatment failure.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2017-4105","type":"journal-article","created":{"date-parts":[[2018,6,4]],"date-time":"2018-06-04T07:20:06Z","timestamp":1528096806000},"source":"Crossref","is-referenced-by-count":50,"title":["Respiratory Viruses and Treatment Failure in Children With Asthma Exacerbation"],"prefix":"10.1542","volume":"142","author":[{"given":"Joanna","family":"Merckx","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics,"},{"name":"Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francine M.","family":"Ducharme","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and"},{"name":"Social and Preventive Medicine, CHU Sainte-Justine, University of Montreal, Quebec, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Martineau","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Infectious Disease, and Immunology, University of Montreal, Montreal, Quebec, Canada;"},{"name":"Laboratoire de Sant\u00e9 Publique du Qu\u00e9bec, Institut National de Sant\u00e9 Publique du Qu\u00e9bec, Sainte-Anne-de-Bellevue, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Zemek","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada;"},{"name":"Children\u2019s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jocelyn","family":"Gravel","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Chalut","sequence":"additional","affiliation":[{"name":"The Montreal Children\u2019s Hospital, McGill University, Montreal, Quebec, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naveen","family":"Poonai","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital, London Health Sciences Centre, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Quach","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada;"},{"name":"Department of Microbiology, Infectious Disease, and Immunology, University of Montreal, Montreal, Quebec, Canada;"},{"name":"Infection Prevention and Control Unit, Division of Infectious Disease and Medical Microbiology, CHU Sainte-Justine, Montreal, Quebec, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Pediatric Emergency Research Canada (PERC) DOORWAY team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2018,7,1]]},"reference":[{"issue":"9743","key":"2021120921383445000_B1","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1016\/S0140-6736(10)61380-3","article-title":"Role of viral respiratory infections in asthma and asthma exacerbations.","volume":"376","author":"Busse","year":"2010","journal-title":"Lancet"},{"issue":"11","key":"2021120921383445000_B2","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1002\/jmv.20725","article-title":"Comparison of multiplex PCR assays and conventional techniques for the diagnostic of respiratory virus infections in children admitted to hospital with an acute respiratory illness.","volume":"78","author":"Freymuth","year":"2006","journal-title":"J Med Virol"},{"issue":"11","key":"2021120921383445000_B3","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1164\/rccm.201303-0498OC","article-title":"Human rhinovirus species C infection in young children with acute wheeze is associated with increased acute respiratory hospital admissions.","volume":"188","author":"Cox","year":"2013","journal-title":"Am J Respir Crit Care Med"},{"issue":"5","key":"2021120921383445000_B4","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1183\/09031936.00092410","article-title":"Association between human rhinovirus C and severity of acute asthma in children.","volume":"37","author":"Bizzintino","year":"2011","journal-title":"Eur Respir J"},{"issue":"5","key":"2021120921383445000_B5","doi-asserted-by":"crossref","first-page":"e64","DOI":"10.1016\/S1473-3099(15)00543-5","article-title":"Global emergence of enterovirus D68: a systematic review.","volume":"16","author":"Holm-Hansen","year":"2016","journal-title":"Lancet Infect Dis"},{"issue":"2","key":"2021120921383445000_B6","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/S2213-2600(14)70252-8","article-title":"Identification of children at risk of influenza-related complications in primary and ambulatory care: a systematic review and meta-analysis.","volume":"3","author":"Gill","year":"2015","journal-title":"Lancet Respir Med"},{"issue":"3","key":"2021120921383445000_B7","doi-asserted-by":"crossref","first-page":"253","DOI":"10.3109\/02770903.2015.1075548","article-title":"Virus and mycoplasma pneumoniae prevalence in a selected pediatric population with acute asthma exacerbation.","volume":"53","author":"Duenas Meza","year":"2016","journal-title":"J Asthma"},{"key":"2021120921383445000_B8","unstructured":"National Institutes of Health\n          . 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