Exacerbation of asthma and airway infection: is the virus the villain?

Abstract

Respiratory viruses are present in the majority of asthmatic children during episodes of exacerbation. The involved physiopathological mechanisms are yet to be fully established, and the synergism between allergic inflammation and viral infection appears to determine uncontrolled disease. The role of other triggering and protective agents is yet to be clearly determined.

The Possible Dual Role of the ACE2 Receptor in Asthma and Coronavirus (SARS-CoV2) Infection

“…Asthmatic patients can suffer from a progressive worsening of symptoms called asthma exacerbation, which necessitates treatment with systemic corticosteroids and eventually mechanical ventilation and intensive care (Dougherty and Fahy, 2009 ). A common concept in asthma is that viral infections can be associated with asthma exacerbation (Costa et al, 2014 ), and in respiratory viral infections, asthma patients can upregulate a wide range of molecules expressed in the lungs; one of these molecules is ACE2 (Bai et al, 2015 ).…”

There Might be a Risk of Anaphylaxis Due to Omalizumab (Anti-IgE) Therapy

“…Rhinoviruses, which are the most common cause of virally induced asthma exacerbations, account for much of the burden of asthma in terms of morbidity, mortality, and associated cost. Asthmatic epithelial cells have an increased intrinsic capacity for expression of a pro-type 2 cytokine in response to a viral infection, and IL-25 is a key mediator of asthma exacerbations of pulmonary inflammation [22][23][24][25]. To our knowledge, this is the first time, an association between omalizumab use and laryngeal oedema has been documented.…”

Respiratory Viral Infections in Exacerbation of Chronic Airway Inflammatory Diseases: Novel Mechanisms and Insights From the Upper Airway Epithelium

“…One of the reasons for the involvement of respiratory viruses' in exacerbations is their ease of transmission and infection (Kutter et al, 2018). In addition, the high diversity of the respiratory viruses may also contribute to exacerbations of different nature and severity (Busse et al, 2010;Costa et al, 2014;Jartti and Gern, 2017). Hence, it is important to identify the exact mechanisms underpinning viral exacerbations in susceptible subjects in order to properly manage exacerbations via supplementary treatments that may alleviate the exacerbation symptoms or prevent severe exacerbations.…”