Respiratory Panel Components and Applications

Common Components of Respiratory Panels

The American Thoracic Society recommends testing for influenza A and B viruses, respiratory syncytial virus (RSV), and multiple other respiratory viruses and select bacterial pathogens, depending on the specific panel being used 1, 2
Respiratory panels typically include viral pathogens such as parainfluenza viruses (types 1-4), human metapneumovirus, rhinovirus, adenovirus, and coronaviruses (229E, OC43, HKU1, NL63) 1, 3, 4
Bacterial pathogens, such as Bordetella pertussis and atypical bacterial pathogens, may be included in some panels 1, 2

The American College of Chest Physicians recommends using nucleic acid amplification techniques, including real-time RT-PCR, multiplex microarray competitive DNA hybridization, nested multiplex RT-PCR, isothermal nucleic acid amplification, and loop-mediated isothermal DNA amplification 1, 2
RT-PCR followed by microarray hybridization is also a commonly used methodology 1, 2

The Infectious Diseases Society of America recommends using nasopharyngeal swabs, nasal swabs, nasal aspirates, nasal washes, throat swabs, and bronchoalveolar lavage (BAL) fluid as specimen types for respiratory panels 1, 2

The American Academy of Pediatrics recommends using respiratory panels to evaluate febrile patients in intensive care units 4
Respiratory panels are also useful in managing immunocompromised patients at high risk for severe respiratory infections 5, 6
The European Respiratory Society recommends using respiratory panels to diagnose pediatric respiratory infections 3

The Centers for Disease Control and Prevention recommends using multiplex respiratory panels due to their decreased turnaround time compared to traditional methods 7
Multiplex respiratory panels also improve detection of co-infections, potentially reduce antibiotic use, and enhance epidemiological surveillance 7

The American College of Chest Physicians notes that upper respiratory tract testing may not be sufficiently sensitive for lower respiratory tract infections, particularly in critically ill and immunocompromised patients 1, 2
Detection of viral nucleic acid does not always correlate with active infection, particularly in immunocompromised hosts who may have prolonged viral shedding 5, 6
Cost considerations may influence panel selection and utilization 7

Multiplex RT-PCR (reverse transcription PCR) is the primary technology used for respiratory panels, as recommended by the American College of Chest Physicians, utilizing PCR methodologies 8, 9, 10, 11

The Infectious Diseases Society of America explicitly recommends RT-PCR or other molecular assays over rapid influenza diagnostic tests (antigen-based) in hospitalized patients to improve detection of influenza virus infection 12

Rapid influenza diagnostic tests (RIDTs)—which are antigen-based—should NOT be used in hospitalized patients except when more sensitive molecular assays are unavailable, and follow-up PCR testing is required to confirm negative antigen test results 12
Antigen tests have significantly lower sensitivity than molecular methods, according to the Infectious Diseases Society of America 12

The term "respiratory panel" specifically refers to multiplex PCR technology, which detects viral nucleic acids with far superior performance characteristics, as distinguished from rapid antigen tests that detect viral proteins with limited sensitivity 8, 9, 12