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Review
. 2017 Oct;140(4):895-906.
doi: 10.1016/j.jaci.2017.08.003.

Role of viral infections in the development and exacerbation of asthma in children

Tuomas Jartti  1 , James E Gern  2
Affiliations
Review

Role of viral infections in the development and exacerbation of asthma in children

Tuomas Jartti et al. J Allergy Clin Immunol. 2017 Oct.

Abstract

Viral infections are closely linked to wheezing illnesses in children of all ages. Respiratory syncytial virus (RSV) is the main causative agent of bronchiolitis, whereas rhinovirus (RV) is most commonly detected in wheezing children thereafter. Severe respiratory illness induced by either of these viruses is associated with subsequent development of asthma, and the risk is greatest for young children who wheeze with RV infections. Whether viral illnesses actually cause asthma is the subject of intense debate. RSV-induced wheezing illnesses during infancy influence respiratory health for years. There is definitive evidence that RSV-induced bronchiolitis can damage the airways to promote airway obstruction and recurrent wheezing. RV likely causes less structural damage and yet is a significant contributor to wheezing illnesses in young children and in the context of asthma. For both viruses, interactions between viral virulence factors, personal risk factors (eg, genetics), and environmental exposures (eg, airway microbiome) promote more severe wheezing illnesses and the risk for progression to asthma. In addition, allergy and asthma are major risk factors for more frequent and severe RV-related illnesses. Treatments that inhibit inflammation have efficacy for RV-induced wheezing, whereas the anti-RSV mAb palivizumab decreases the risk of severe RSV-induced illness and subsequent recurrent wheeze. Developing a greater understanding of personal and environmental factors that promote more severe viral illnesses might lead to new strategies for the prevention of viral wheezing illnesses and perhaps reduce the subsequent risk for asthma.

Keywords: Asthma; bronchiolitis; child; exacerbation; respiratory syncytial virus; rhinovirus; virus; wheeze; wheezing.

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Figures

Fig 1
Fig 1
RV and RSV interactions with airway epithelial cells. ICAM-1, Intercellular adhesion molecule 1; LDL-R, low-density lipoprotein receptor.
Fig 2
Fig 2
Interacting factors that contribute to the severity of virus-induced wheezing illnesses and the risk for subsequent development of childhood asthma.
Fig 3
Fig 3
Opportunities for treatment or prevention of virus-induced wheezing illnesses. Potential interventions are shown in red. OMZ, Omalizumab.
See this image and copyright information in PMC

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