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Review
. 2020 Feb;42(1):61-74.
doi: 10.1007/s00281-020-00781-5. Epub 2020 Jan 27.

Role of viruses in asthma

Tuomas Jartti  1 , Klaus Bønnelykke  2 , Varpu Elenius  1 , Wojciech Feleszko  3
Affiliations
Review

Role of viruses in asthma

Tuomas Jartti et al. Semin Immunopathol. 2020 Feb.

Abstract

Respiratory viral infections are the most important triggers of asthma exacerbations. Rhinovirus (RV), the common cold virus, is clearly the most prevalent pathogen constantly circulating in the community. This virus also stands out from other viral factors due to its large diversity (about 170 genotypes), very effective replication, a tendency to create Th2-biased inflammatory environment and association with specific risk genes in people predisposed to asthma development (CDHR3). Decreased interferon responses, disrupted airway epithelial barrier, environmental exposures (including biased airway microbiome), and nutritional deficiencies (low in vitamin D and fish oil) increase risk to RV and other virus infections. It is intensively debated whether viral illnesses actually cause asthma. Respiratory syncytial virus (RSV) is the leading causative agent of bronchiolitis, whereas RV starts to dominate after 1 year of age. Breathing difficulty induced by either of these viruses is associated with later asthma, but the risk is higher for those who suffer from severe RV-induced wheezing. The asthma development associated with these viruses has unique mechanisms, but in general, RV is a risk factor for later atopic asthma, whereas RSV is more likely associated with later non-atopic asthma. Treatments that inhibit inflammation (corticosteroids, omalizumab) effectively decrease RV-induced wheezing and asthma exacerbations. The anti-RSV monoclonal antibody, palivizumab, decreases the risk of severe RSV illness and subsequent recurrent wheeze. A better understanding of personal and environmental risk factors and inflammatory mechanisms leading to asthma is crucial in developing new strategies for the prevention and treatment of asthma.

Keywords: Asthma; Bronchiolitis; Child; Exacerbation; Genetics; Pathogenesis; Respiratory syncytial virus; Rhinovirus; Risk; Virus; Wheeze; Wheezing.

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Conflict of interest statement

WF has received speaker honoraria from Vifor Pharma. VE and KB declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Virus etiology from bronchiolitis and childhood wheezing to asthma. RSV, respiratory syncytial virus; RV, rhinovirus; hBoV, human bocavirus; Flu, influenza virus; EV, enteroviruses; MPV, metapneumovirus; PIV, parainfluenza virus; AdV, adenovirus
Fig. 2
Fig. 2
Major factors influencing asthma risk in young children suffering from bronchiolitis. RV, rhinovirus; virus; n-3 LCPUFA, n-3 (omega-3) long-chain polyunsaturated fatty acids
Fig. 3
Fig. 3
Airway epithelial pathways impacted by environmental exposures and type 2 immune responses in asthma pathogenesis. Exposure to air pollutants (cigarette smoke, diesel particle, etc.) cause oxidative stress. Mold and other allergens stimulate epithelial cells and induce activation of proinflammatory cytokines and chemokines. Respiratory viruses (RV and RSV) interact with specific receptors on epithelial cells. Damaged or dysregulated epithelial barrier in asthmatic patients also affects type 2 inflammation. Release of cytokines and chemokines promotes activation and mobilization of type 2 immune responses. CDHR3, cadherin-related family member 3; CX3CR1, CX3C chemokine receptor 1; ICAM-1, intercellular adhesion molecule 1; IFN, interferon; IgE, immunoglobulin E; IL, interleukin; LDLR, low-density lipoprotein receptor; RV-A, RV-B, RV-C, rhinovirus-A, rhinovirus-B, rhinovirus-C; RSV-A, RSV-B, respiratory syncytial virus-A, virus-B
Fig. 4
Fig. 4
Summary of environmental factors affecting developmentaand exacerbationsbof asthma. A) Interplay of environmental (air pollution, allergens, viruses) and host (genetic, microbiome) factors shape the risk of asthma development and predispose to different asthma phenotypes. B) Environmental exposures to allergens (animal, pollen, mold), viruses, cigarette smoke, and air pollution are known triggers for asthma exacerbations. Thunderstorms are associated with asthma exacerbations. Thunderstorms produce ozone and release allergen-bearing small particles that irritate airways. Avoidance of environmental exposures can improve asthma control and reduce exacerbations
Fig. 5
Fig. 5
Current strategies for asthma prevention and treatment. Details in text. RV, rhinovirus; RSV, respiratory syncytial virus
See this image and copyright information in PMC

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