Epidemiologic, experimental, and clinical links between respiratory syncytial virus infection and asthma

Abstract

Virtually all children experience respiratory syncytial virus (RSV) infection at least once during the first 2 years of life, but only a few develop bronchiolitis and more severe disease requiring hospitalization, usually in the first 6 months of life. Children who recover from RSV-induced bronchiolitis are at increased risk for the development of recurrent wheeze and asthma in later childhood. Recent studies suggest that there is an association between RSV-induced bronchiolitis and asthma within the first decade of life but that this association is not significant after age 13. Despite the considerable progress made in our understanding of several aspects of respiratory viral infections, further work needs to be done to clarify the molecular mechanisms of early interactions between virus and host cell and the role of host gene products in the infection process. This review provides a critical appraisal of the literature in epidemiology and experimental research which links RSV infection to asthma. Studies to date demonstrate that there is a significant association between RSV infection and childhood asthma and that preventing severe primary RSV infections can decrease the risk of childhood asthma.

FIG. 1.

Epithelial cell as the target of RSV and possible role of NF-κB (hence the question mark) in mediating RSV-induced activation of genes. RSV infection upregulates the expression of several proinflammatory and allergy- and asthma-related cytokines and chemokines in cultured epithelial cells (1, 2, 25, 134). GM-CSF, granulocyte-monocyte colony-stimulating factor; FcER1α, Fc fragment of alpha subunit high-affinity (I) IgE receptor; iNOS, inducible nitric oxide synthase; MUC-1, mucin-1.