Prevalence and clinical outcome of Respiratory Syncytial Virus (RSV) and Influenza in COPD patients hospitalized with acute exacerbation

<bold>Background:</bold> COPD exacerbation (AECOPD) are associated with disease progression and impose significant burden on health systems. Respiratory viruses are responsible for one third of AECOPD. RSV vaccines are recommended to individuals over 60 with chronic lung disease. However, the benefit of RSV vaccination in reducing the burden of severe COPD exacerbation is unclear. Thus, we studied the incidence of RSV-infections among hospitalized COPD patients (RSV-AECOPD) <bold>Methods:</bold> Data was extracted with MDclone platform from 7 hospitals network database. All AECOPD hospitalization between 2018 – 2021 were included provided bacterial infection excluded, and nasal swab PCR test for respiratory viruses completed. For each subject we evaluated risk factors, exacerbation severity, and outcome. We further compared RSV-AECOPD with influenza-AECOPD and all other AECOPD <bold>Results:</bold> Among 2762 hospitalized AECOPD, 324 (11.8%) tested positive for influenza and 70 (2.6%) tested positive to RSV. Baseline characteristics and comorbidities were comparable between groups. RSV-AECOPD had longer admissions (3.42±3 vs 4.56±3.47 days, p=0.011) and increased need for non-invasive ventilation (19% vs 10%, p=0.037). 30 and 90-days mortality was increased but did not reach statistical significance (2.5 vs 4.4, and 4.9 vs 7.4, respectively, NS). <bold>Conclusion:</bold> Our data suggest that RSV-AECOPD has worse outcome, but it was relatively uncommon cause of severe AECOPD in our region. These finding emphasize that any vaccination program should consider the expected benefits and expected burden reduction against the resources invested.