Respiratory syncytial virus (RSV) in adults and those with certain chronic conditions can pose many serious health concerns, just as it does among young infants.

RSV is a common respiratory infection. As with many other viruses, case numbers spike during the winter season, often coinciding with influenza, which has almost identical symptoms.

Many parents are aware of the risk RSV poses to infants. However, older adults and people with certain chronic conditions are also at risk for developing serious illness from RSV.

This article explores why RSV becomes more severe with age and which groups are the most at-risk.

Older adults are among those most likely to experience severe RSV illness.

The Centers for Disease Control and Prevention (CDC) indicate up to 120,000 older adults in the United States are admitted to the hospital for RSV annually, and the virus is responsible for up to 10,000 adult deaths each year.

Why RSV has a significant affect on the older population has much to do with natural immune system aging. Right around the age of 60 years, the immune system starts to slow down. It becomes less capable of supporting wound healing and preventing infection.

As age progresses, the immune system continues to weaken through a process known as immunosenescence.

Even though most people are exposed to RSV multiple times throughout life, immunity does not last. This means there will be times when the body must fight off the virus as if it were the first exposure.

As immune system function declines, so does the ability to fight off RSV — and any infection.

Any time the immune system is compromised, there is the potential for RSV infection to be severe.

The CDC states adults at the most risk for severe RSV include:

  • older adults, especially those who are 65 years and older
  • adults with weakened immune systems
  • adults living with chronic lung or heart disease

Groups at high risk for RSV

It is possible to experience short-term conditions that might worsen RSV symptoms, but some groups have a higher risk for RSV complications overall.

These include people with conditions such as:

  • asthma
  • congestive heart failure
  • chronic obstructive pulmonary disease (COPD)

In these populations, the respiratory symptoms of RSV can compound existing challenges. Lung infections or pneumonia can worsen symptoms by reducing lung function and blood oxygen levels.

For example, a 2022 study published in PLOS One found that living with congestive heart failure was associated with an eightfold increased risk of hospitalization with RSV.

Congestive heart failure is associated with tissue congestion, caused by the heart’s inability to pump blood properly. Fluid can collect in the lungs, causing pulmonary edema.

Alone, pulmonary edema can lead to shortness of breath or respiratory distress. When paired with RSV lung complications, breathing ability can further decline.

Ultimately, chronic conditions that already involve the lungs may be among those most affected by RSV.

RSV in adults is a growing concern that may account for up to 10% of respiratory illness hospitalizations worldwide in adults over 50 years.

Below are some common questions about RSV in older adults and adults with chronic conditions.

Do adults with lung conditions have a higher risk of RSV?

Compared with the general population, adults with asthma, COPD, and congestive heart failure have a higher risk for severe RSV infection.

How long does RSV last in older adults?

RSV infections tend to resolve on their own within 2 weeks for younger, healthy adults. However, in vulnerable populations, a person may require hospitalization.

According to a 2022 retrospective review of patient charts published in Health Science Reports, the average hospitalization stay for adults with RSV was 6 days. The majority of people were in an emergency room setting, with a mean age of 60 years.

Will RSV worsen certain conditions?

RSV can worsen other conditions, such as asthma, COPD, or congestive heart failure, by affecting lung function and capacity.

What makes RSV in adults different from influenza?

Influenza tends to have a more rapid symptom onset combined with high fever than RSV.

While RSV can sometimes cause fever, it is not as common.

In addition, influenza severity tends to fluctuate yearly depending on the strain, while severe RSV symptoms have remained consistent over the years.

RSV symptoms in older adults include:

  • runny nose
  • sore throat
  • cough
  • headache
  • shortness of breath
  • pneumonia
  • worsening of symptoms in chronic conditions such as asthma

There is no vaccine or specific treatment for RSV, though research for potential therapies is underway.

For older adults, care focuses on maintaining comfort, managing fever when present, and preventing RSV from progressing into a life threatening respiratory illness.

RSV transmission in older adults and those with chronic conditions can be managed by:

  • regular handwashing
  • avoiding close contact with someone who may be sick
  • keeping hands away from eyes, nose, and mouth
  • covering coughs and sneezes, ideally with a disposable tissue
  • disinfecting surfaces that people regularly touch, such as sink handles, door knobs, light switches, and countertops
  • staying home when not feeling well — RSV is usually contagious for 3–8 days. For people with weakened immune systems, RSV may remain transmissible for up to 4 weeks.

It is not clear whether wearing a face mask can prevent the transmission of RSV.

Early research suggests masks are not superior to handwashing. However, a 2021 review in Wiley Public Health Emergency Collection suggests face masks may help limit the spread of RSV by providing a barrier against droplets.

According to the American College of Emergency Physicians, people should seek emergency care for RSV if:

  • breathing becomes difficult
  • skin color is blueish, particularly on the nails or lips
  • a high fever develops

Visiting an emergency facility when sickness feels severe or impairing can help prevent serious complications and even death.

RSV in adults can pose significant risks for those older or living with chronic conditions.

It may also worsen some conditions, such as asthma, COPD, and congestive heart failure.

Anyone experiencing severe symptoms should seek medical care immediately.