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Review
. 2016 May;52(5):269-73.
doi: 10.1016/j.arbres.2015.11.008. Epub 2016 Jan 4.

Pediatric Asthma and Viral Infection

[Article in English, Spanish]
Affiliations
Review

Pediatric Asthma and Viral Infection

[Article in English, Spanish]
M Luz Garcia-Garcia et al. Arch Bronconeumol. 2016 May.

Abstract

Respiratory viral infections, particularly respiratory syncytial virus (RSV) and rhinovirus, are the most importance risk factors for the onset of wheezing in infants and small children. Bronchiolitis is the most common acute respiratory infection in children under 1year of age, and the most common cause of hospitalization in this age group. RSV accounts for approximately 70% of all these cases, followed by rhinovirus, adenovirus, metapneumovirus and bocavirus. The association between bronchiolitis caused by RSV and the development of recurrent wheezing and/or asthma was first described more than 40years ago, but it is still unclear whether bronchiolitis causes chronic respiratory symptoms, or if it is a marker for children with a genetic predisposition for developing asthma in the medium or long term. In any case, sufficient evidence is available to corroborate the existence of this association, which is particularly strong when the causative agent of bronchiolitis is rhinovirus. The pathogenic role of respiratory viruses as triggers for exacerbations in asthmatic patients has not been fully characterized. However, it is clear that respiratory viruses, and in particular rhinovirus, are the most common causes of exacerbation in children, and some type of respiratory virus has been identified in over 90% of children hospitalized for an episode of wheezing. Changes in the immune response to viral infections in genetically predisposed individuals are very likely to be the main factors involved in the association between viral infection and asthma.

Las infecciones por virus respiratorios, especialmente virus respiratorio sincitial (VRS) y rinovirus, suponen el mayor factor de riesgo para la aparición de episodios de sibilancias en lactantes y niños pequeños. La bronquiolitis es la infección respiratoria aguda de vías respiratorias inferiores más común en menores de un año y constituye la causa más frecuente de hospitalización en este grupo de edad. El VRS causa aproximadamente el 70% de todas ellas, seguido por rinovirus, adenovirus, metapneumovirus o bocavirus. La asociación entre bronquiolitis por VRS y desarrollo de sibilancias recurrentes y/o asma ha sido descrita hace más de 4 décadas, aunque en la actualidad se desconoce con exactitud si la bronquiolitis es la causa de los síntomas respiratorios crónicos o si, más bien, es un marcador que señala a los niños con predisposición genética a desarrollar asma a medio o largo plazo. En cualquier caso, existe evidencia suficiente como para afirmar que esta asociación existe y que es especialmente intensa si el agente asociado a la bronquiolitis es el rinovirus.

El papel patogénico de los virus respiratorios como desencadenantes de exacerbaciones en el paciente asmático no está totalmente aclarado, pero sin duda los virus respiratorios, y en especial el rinovirus, son el desencadenante más frecuente de exacerbaciones asmáticas en los niños, llegando a identificarse algún virus respiratorio hasta en el 90% de los niños hospitalizados por un episodio de sibilancias. Muy probablemente, las alteraciones en la respuesta inmune frente a las infecciones virales en sujetos genéticamente predispuestos sean los principales implicados en la asociación virus-asma.

Keywords: Asma; Asthma; Bocavirus humano; Bronchiolitis; Bronquiolitis; Human bocavirus; Human metapneumovirus; Metapneumovirus humano; Respiratory syncytial virus; Respiratory viruses; Rhinovirus; Rinovirus; Virus respiratorio sincitial; Virus respiratorios.

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