Respiratory virus prevalence is higher in acute asthma than stable asthma across children and adults

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European respiratory review : an official journal of the European Respiratory Society Published April 10, 2026 Medically reviewed May 25, 2026 Study authors: Ananth Sachin, Alimani Gioulinta S, Boccabella Cristina, Khaleva Ekaterina, Hansel Jan, Wang Ran, Ro… PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Note that respiratory virus prevalence is higher in acute asthma, but diagnostic utility may be limited without complementary biomarkers.

This systematic review and meta-analysis evaluated the prevalence of respiratory viruses in patients with asthma. The pooled dataset included 111 eligible studies covering both children and adults. The primary outcome measured was the prevalence of any respiratory virus, with secondary analyses focusing on rhinovirus in acute settings.

In patients with stable asthma, the pooled prevalence of any respiratory virus was 33.9% (95% CI 24.8-43.7%) in children and 23.0% (95% CI 12.9-35.0%) in adults. During acute asthma episodes, prevalence increased to 58.8% (95% CI 52.5-65.0%) in children and 49.9% (95% CI 41.2-58.5%) in adults. Specifically, rhinovirus prevalence was 45.0% in children and 21.2% in adults with acute asthma.

No specific safety data, adverse events, or tolerability information were reported in the included studies. The evidence is classified as moderate-certainty. A key limitation is that the setting was not reported for the individual studies, and no specific comparator group was defined beyond the stable vs. acute distinction. The authors note that the diagnostic value of a positive viral test during acute episodes may be limited.

To improve clinical interpretation, complementary biomarkers may be beneficial. The evidence suggests a potential association with more severe acute attacks, but causal links cannot be established from this observational synthesis. Clinicians should consider these prevalence rates when evaluating respiratory symptoms but avoid overreliance on viral testing alone for diagnosis.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedApr 2026

PMID41951240

View Original 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 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 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.