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Review
. 2025 Jul 31;17(8):1073.
doi: 10.3390/v17081073.

Predictive Factors and Clinical Markers of Recurrent Wheezing and Asthma After RSV Infection

Luca Buttarelli  1 , Elisa Caselli  1 , Sofia Gerevini  1 , Pietro Leuratti  1 , Antonella Gambadauro  2 , Sara Manti  2 , Susanna Esposito  2
Affiliations
Review

Predictive Factors and Clinical Markers of Recurrent Wheezing and Asthma After RSV Infection

Luca Buttarelli et al. Viruses. .

Abstract

Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory infections (ALRIs) in young children, especially bronchiolitis, with significant global health and economic impact. Increasing evidence links early-life RSV infection to long-term respiratory complications, notably recurrent wheezing and asthma. This narrative review examines these associations, emphasizing predictive factors and emerging biomarkers for risk stratification. Early RSV infection can trigger persistent airway inflammation and immune dysregulation, increasing the likelihood of chronic respiratory outcomes. Risk factors include severity of the initial infection, age at exposure, genetic susceptibility, prematurity, air pollution, and tobacco smoke. Biomarkers such as cytokines and chemokines are showing promise in identifying children at higher risk, potentially guiding early interventions. RSV-related bronchiolitis may also induce airway remodeling and promote Th2/Th17-skewed immune responses, mechanisms closely linked to asthma development. Advances in molecular profiling are shedding light on these pathways, suggesting novel targets for early therapeutic strategies. Furthermore, passive immunization and maternal vaccination offer promising approaches to reducing both acute and long-term RSV-related morbidity. A deeper understanding of RSV's prolonged impact is essential to develop targeted prevention, enhance risk prediction, and improve long-term respiratory health in children. Future studies should aim to validate biomarkers and refine immunoprophylactic strategies.

Keywords: RSV; asthma; biomarkers; bronchiolitis; prevention; wheezing.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Risk and protective factors involved in severe RSV infection in childhood and the subsequent development of recurrent wheezing and asthma.
Figure 2
Figure 2
Proposed immunological pathways linking RSV infection to recurrent wheezing and asthma, highlighting Th2/Th17 imbalance, cytokine profiles, airway remodeling, and genetic susceptibility factors.
See this image and copyright information in PMC

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