Risk Factors for Severe RSV Infection


Key opinion leaders discuss risk factors for RSV and patient populations most susceptible to the disease.

Ryan Haumschild, PharmD, MS, MBA: Pharmacists have played a huge role recently, especially with vaccinations and testing. You’ve been a huge advocate as we’ve treated COVID-19 and tested for it more frequently. If we have more of these tests, they fall within panels. How do you see RSV [respiratory syncytial virus] testing aligning with a lot of the pharmacists and the different pharmacies and clinics across the country? Is that something that pharmacies will own more?

Christina Madison, PharmD, FCCP, AAHIVP: If we lived in a perfect world, and if I had my way, yes. But that’s not something I can wave a magic wand and change about our health care system. As 1 of the most accessible and underutilized portions of the health care system, pharmacists will have an opportunity. We’ve already proven we can not only do it but do it well. Looking at what we’ve been able to accomplish in the last 2 years with COVID-19, I’m excited to see us embark on this new venture. We’re seeing more opportunities for known diagnoses that may be medication intensive for pharmacists to manage. They may be able to reduce the population health and public health burden of disease because we’re treating something quicker and not having that individual out in society and able to spread a communicable illness.

Ryan Haumschild, PharmD, MS, MBA: It’s spreading the communicable illness, reducing the cost of care, and providing better outcomes for our community, which we’re all aligned around. Ms Madison, I have another question for you. We’ve heard about RSV and detecting it, but a lot of healthy individuals that have RSV may not be symptomatic. What are some of the risk factors for severe RSV infections? How does it impact vulnerable populations, such as older adults and the immunocompromised? If you could give us a little of detail there, that would be appreciated.

Christina Madison, PharmD, FCCP, AAHIVP: We all know that as we age, our immune system isn’t as capable as it once was to handle infections when we’re exposed in the environment. The big group of individuals who are at the highest risk is individuals 65 years and older, because of the likelihood of their immune system not being as competent as they age. Also, anyone who has COPD [chronic obstructive pulmonary disease] or reactive airway disease, former smokers, and anyone who is immunosuppressed due to drugs or disease state. I like to make sure that I clarify the 2 because there are plenty of patients who may not have a compromised immune system, but for whatever reason, we’re treating a chronic medical disease that requires them to be on chronic immunosuppression.

Ryan Haumschild, PharmD, MS, MBA: As we’re talking about these patients, more are in the aging population, so we’re seeing a lot of comorbidities. Something individuals should also think about is the mortality rate related to RSV. A lot of our viewers are pharmacists, providers, physicians, or payers, and they’re always trying to think about the importance of treating RSV. We have hospitalizations, and we can reduce costs, but we also want to think about the mortality rate associated with these infections. Are you able to speak to that?

Christina Madison, PharmD, FCCP, AAHIVP: When we look at who’s at risk, our biggest concern is about who is more likely to have complications. It’s patients who are at the highest risk for severe complications, defined as someone likely to be hospitalized, potentially need supplemental oxygen, and then also someone who may succumb to secondary bacterial pneumonia. Those individuals are over 65 years old, are already on an immunocompromising medication, or have a history of reactive airway disease—COPD in particular because former smokers have underlying lung damage and alveoli damage that causes them to be more likely to have complications associated with RSV. If you have those things and you don’t seek care, and now you’re convalescing at home and aren’t seeking the health care system, that’s going to increase your risk for morbidity and mortality and ultimately hospitalization and death.

Adam C. Welch, PharmD, MBA, FAPhA: What an opportunity for community pharmacists. We’re positioned to ask the name and birth date of every individual who walks through the door. We talked about immunosenescence, declining immunity as we age. We ask for our patients’ ages every time they come in; we know our patients. We can identify that risk. If they’re coming in for a medication for COPD or heart failure, and they’re on an angiotensin receptor neprilysin inhibitor, on sacubitril, we can say, “With that heart failure diagnosis, now you’re at risk for severe complications.”

Christina Madison, PharmD, FCCP, AAHIVP: Absolutely.

Adam C. Welch, PharmD, MBA, FAPhA: That’s a great opportunity for community pharmacists to be in the forefront to have that conversation about RSV, the prevention options coming for RSV, and what we can do to alleviate this disease.

Christina Madison, PharmD, FCCP, AAHIVP: Thank you for pointing that out. That’s on the list of complications, specifically heart failure. I want to make sure I mention that again. Thank you for making sure we didn’t miss that point. We do have a lot more individuals now who aren’t in that more mature age group that may have cardiovascular risk and should probably be assessed. Heart failure is also on that list.

Adam C. Welch, PharmD, MBA, FAPhA: If we can test with the same nasal swab that we test for COVID-19, flu, and RSV, that’s going to give us more information.

Christina Madison, PharmD, FCCP, AAHIVP: Triple threat.

Ryan Haumschild, PharmD, MS, MBA: You’ve all made a great argument that we should be testing more for RSV. There’s a huge opportunity within the pharmacy to make sure we’re screening these patients appropriately and making sure we can help prevent the severity of this disease.

Transcript edited for clarity.

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