Increased Risk of Severe RSV Illness in Adults With Asthma or COPD

Adults with asthma or chronic obstructive pulmonary disease (COPD) face a higher risk of severe respiratory syncytial virus (RSV)-related illness, including hospitalization, respiratory complications and death, according to a study published in Current Allergy and Asthma Reports in January 2025.

RSV is a common virus that affects the lungs and airways, typically causing mild cold-like symptoms in healthy people—primarily targeting young children and older adults.

However, RSV can lead to serious complications in adults with chronic respiratory conditions like asthma and COPD.

Young woman with asthma inhaler.

The virus can trigger severe flare-ups in asthma and COPD, increasing the risk of hospitalization, intensive care admission and even death.

Historically, RSV has been studied mainly in infants and older adults, but recent research shows that it also poses a significant threat to adults with asthma and COPD.

However, research on the virus in these groups has been limited.

To better understand its impact on these high-risk groups, researchers followed preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to examine the burden of RSV in adults aged 18 and older with asthma or COPD.

The study included research published between 2000 and 2023 from high-income countries with more than a GNI per capita of $14,005— the United States, Canada, most European nations and more—focusing on laboratory-confirmed RSV cases.

Studies reporting hospitalization rates, complications and mortality were included, while those with non-representative populations were excluded.

Out of 40 studies, the results showed high prevalence rates of asthma at 19.3% and COPD at 30.8% among RSV-infected adults, particularly in inpatient settings.

Adults with these conditions were more likely to be hospitalized due to RSV, with hospitalization rates significantly higher for those with COPD from 3.2 to 13.4 times and asthma from 2.0 to 8.2 times.

Severe complications were common, including worsened asthma and COPD symptoms, with up to 64.9% of asthma patients and more than 83.0% of COPD patients experiencing worsened respiratory conditions.

In addition, ICU admissions and mechanical ventilation were also frequently reported among these patients. In-hospital mortality rates ranged from 2.6% to 17.8%, depending on the condition, also.

This study provides valuable insights into the burden of RSV infection in adults with asthma or COPD.

For example, one of its many strengths is the thorough search strategy and the high quality of most studies, which were examined using the Joanna Briggs Institute (JBI) checklist—evaluating how well a study was done and whether it has addressed any potential bias in its design, execution and analysis.

Another strength includes the finding of a high prevalence of asthma and COPD in RSV-infected adults, particularly in inpatient settings, with a significant increase in hospitalization risk for these patients.

The study also highlighted severe RSV complications, such as exacerbations of underlying respiratory conditions, ICU admissions and mechanical ventilation.

However, there are several limitations.

For example, the study could be biased due to the exclusion of studies with small sample sizes or negative findings and the lack of formal statistical tests for publication bias.

In addition, demographic factors such as gender and ethnicity were not observed, as most studies did not provide this data.

Differences between studies in age groups, settings and diagnostic methods created inconsistency, which could affect the strength of the findings.

The focus on high-income countries could also mean the results may not apply to low- and middle-income settings, where RSV burden may differ.

Lastly, the study focused more on inpatient settings, leaving a gap on RSV's impact on outpatient populations.

Researchers suggest further investigation on the long-term effects of RSV infection in adults with asthma or COPD, including its impact on lung function.

More data on outpatient RSV cases and studies from low- and middle-income countries are also urged.