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What Is Viral Induced Asthma

What Are The Symptoms Of A Viral

How to Manage Viral Induced Asthma During Cold and Flu Season

An asthma flare-up is bronchospasm and inflammation of the lungs, says Pierrette Mimi Poinsett, MD, a medical consultant atMom Loves Best. Respiratory infections including viruses can trigger asthma flares. The symptoms of a viral-induced asthma flare-up are similar to regular asthma symptoms, and can include:

  • Wheezing
  • Headache
  • Sinus pain

Its a good sign that its viral-related if your asthma is typically well-controlled, and these signs appear alongside a viral illness.;

Asthma symptoms occur on a spectrum from mild to severe. A serious asthma attack can be life-threatening, so its important to recognize the symptoms. If you develop signs such as difficulty breathing, flaring of the nostrils, difficulty talking or walking, and/or bluish tint to lips, skin, or nails, call 911 and seek medical help immediately.;

What makes asthma worse? In addition to viral illness, some other commontriggers of an asthma flare-up are:

  • Exercise
  • Weathercold temperatures or allergy season
  • Medications like beta-blockers
  • Gastroesophageal reflux

When an asthma flare-up occurs, it could take several days or weeks before your bronchial tubes are no longer constricted, depending on how severe the condition is.

Why Do They Exist

The sole purpose of a virus’s existence is to invade a cell and replicate. Due to their simple structures, they don’t have the means of hunting for cells to invade. For this reason, when they come into contact with a cell they like, its merely a coincidence. So, it’s not like they are out and about hunting for respiratory cells to invade.

The Clinical Association Between Respiratory Viral Infections And Asthma

Respiratory syncytial virus and RV belonging to Paramyxoviradae and Picornaviradae family, respectively, are single-stranded RNA viruses involved in the infectious processes of the human respiratory tract. They are the respiratory viruses that have been more commonly associated with the development of asthma or asthma exacerbation. Other viruses such as influenza virus also seem to have an impact on asthma, while coronavirus, adenovirus, parainfluenza virus, metapneumovirus or bocaviruses have been described as potential risk factors for asthma exacerbations, although at a lower extend.,

The clinical association between respiratory viral infections and asthma can also be analysed from the perspective of the predisposition that an asthmatic background has for the development of a higher number and/or more severe viral infections in the airways. In that respect, data from several clinical studies have revealed that atopic paediatric patients may have a higher risk of adverse responses to respiratory viral infections, such as the ones produced by RV, and those infections are significantly related with wheezing in children that were hospitalized due to asthma., In young adults it has also been found that an asthmatic background with high levels of total IgE seems to be predisposed to exacerbated responses to acute infections with viruses such as RV.

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Respiratory Viral Infections As A Risk Factor For Asthma Development: Mechanisms Involved

Different mechanisms have been suggested to be involved in the initiation or exacerbation of asthma as a consequence of respiratory viral infections. Although the severity and the outcomes of a respiratory viral infection depend on factors such as the host immune system or environmental aspects, it has been observed that respiratory viral infections can induce per se immunological changes and morphological alterations that can contribute to the initiation or aggravation of asthmatic processes . Infections produced by respiratory viruses such as RSV or RV are characterized by airways inflammation and tissue remodelling that could have an impact on the initiation of asthmatic processes.

Figure 1

What Makes Yale Medicines Approach To Pediatric Asthma Unique

Asthma Part 1

The Pediatric Asthma Program at Yale Medicine brings all aspects of a childs care team together, ensuring that each patient receives individualized attention and the best possible treatment. Patients are seen by specialists with extensive experience in asthma and related conditions, and also meet with registered nurses who are certified asthma educators. All details of the visit are communicated back to the childs primary care provider.

The nurse educators spend time with each family at the end of their visit and go through proper use of medications, show them how to use their inhalers, and give them advice on controlling environmental factors, Dr. Bazzy-Asaad says.;If a child has certain allergies, for example, theyll talk about how to avoid those triggers.

Pediatricians working with the Asthma Program regularly collaborate with experts in other departments,;too. If theres a situation that doesnt seem like straightforward asthma, its very easy for us to work with other specialists to get to the bottom of the problem more quickly, Dr. Bazzy-Asaad says.

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Viral Asthma And Coronavirus

Of course, the concerns asthma sufferers confront every fall and winter are magnified this year due to the risk of Covid-19. The coronavirus pandemic is of special concern to those with asthma for a few reasons, including:

  • A person with asthma may be at greater risk for getting seriously ill if they contract Covid-19
  • Another fast-spreading virus in the mix during cold and flu season increases the chances of catching something that may aggravate asthma
  • Asthma sufferers with respiratory symptoms may have a difficult time discerning whether theyre sick with a virus or simply experiencing a flare-up

That means its all the more important for someone who has been diagnosed with asthma to take precautions to avoid Covid-19 and to get tested as soon as possible if Covid-like symptoms appear.

Role Of Other Inflammatory Pathways In Virus

In the initiation of asthma, other immune mechanisms besides or in a combination with type 2 inflammation can take place, such as neutrophilic inflammation in which Th1 and Th17 cells play an important role. In this context, it has been observed that asthma can be initiated by respiratory viruses by the activation of immune mechanisms different from the ones involved in type 2 inflammation, although they can also act in combination with this type of inflammation. In that respect, in a mouse model of virus-induced asthma, the signalling of IL-1β has been implicated in neutrophilic inflammation. IL-17, a pro-inflammatory cytokine produced by Th17 cells, which is known to contribute to asthma by the induction of lung inflammation, mucus production and promotion of Th2 responses, has been found to be augmented during RSV infections and to play a key role in the pathogenesis of asthma induced by RSV. Other studies have confirmed that Th17 and Th2 pathways seem to be implicated in the response to RSV infection, which can derive in persistent type 2 immunity implicated in asthma.,

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Immunomodulators And Bacterial Lysates

Among several non-specific anti-viral approaches to reduce asthma include strategies aiming at enhancing the patients resistance to multiple respiratory viruses through the administration of immunostimulatory preparations . Pidotimod is a synthetic thymic dipeptide that appears to share several mechanistic similarities with bacterial immunomodulators, and it is thought to stimulate toll-like receptor 2 and TLR4, which are expressed on DCs, this displaying anti-infective effects. To date, there is only one prospective multicenter trial, showing that pidotimod reduced the number of respiratory infections in a mixed group of children over half of whom had atopic conditions, including asthma .

Bacterial lysates have recently been proved to reduce the number of the recurrent wheezing episodes and asthma episodes, in patients treated with BL compared with placebo . However, higher-quality trials are required before firm conclusions can be drawn regarding the prophylactic efficacy of bacterial lysates in asthma. A new large scale trial, currently carried out in the USA will address these concerns, but its results are expected in 2022.

The Role Of Secondary Or Co

What is Exercise Induced Asthma?

Other pathogens have co-evolved with viruses and are able to use the window of opportunity created by viral infection and superinfect the host . For example, it is well known that the rate of bacterial infection increases during episodic viral pandemics . One mechanism by which superinfection occurs is by increased binding and retention of bacteria to the respiratory epithelium . Furthermore, we have also shown that the innate immune response to bacteria is markedly impaired in virally infected alveolar macrophages . In comparison to other diseases and pathogens, the role of bacterial infections in asthma exacerbations is controversial. However, asthmatics have increased susceptibility to invasive bacterial infection , and atypical bacterial infection has been reported to be reactivated in virus-induced asthma exacerbations and related to exacerbation frequency . There is also evidence that macrolide antibiotics, when used prophylactically , or after the occurrence of an acute exacerbation are effective treatments for asthma. If bacteria are co-conspirators in virus-induced exacerbations, it is highly likely that the exacerbation would not respond to ICS and 2-agonists, as these drugs would not inhibit bacterial growth. Further research is needed in this area to fully describe the role of bacteria in virus-induced exacerbations.

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What Level Of Oxygen Saturation Is Acceptable

There are differing opinions regarding target oxygen saturation in patients with bronchiolitis. Most would agree on a target somewhere between 94% and 92%. But which?

Consider the oxygen-haemoglobin dissociation curve:

Conditions that push the curve to the right , are decreasing pH, increasing temperature.

Thus, in a febrile, acidotic child the curve is pushed to the right, requiring a higher PO2 to maintain the same level of saturation and thus;increasing the likelihood of desaturations. In these children, aiming for an SaO2 of 94% would be reasonable. Local guidelines may have differing suggestions.

Chemical ‘key’ Found To Virus

Chemical Messenger May Reveal if Asthma Attack Is Due to Allergy or Virus

Aug. 15, 2005 — A chemical messenger in the blood can tell doctors whether the cause of an asthma attack is a virus or an allergy.

The finding may one day lead to a new treatment for most severe asthma attacks. It would be an important advance. An asthma attack associated with a viral respiratory infection can begin rapidly and be quite severe.

The study found that virus infections are behind nearly 80% of severe asthma attacks. In the vast majority of cases, the culprit is the common cold virus, which typically shows symptoms such as fever, cough, and upper airway symptoms such as nasal congestion. Asthma is a disease of the lower airways, making breathing difficult.

Peter G. Gibson, MBBS, of John Hunter Hospital in New Lambton, Australia, and colleagues report the findings in the August issue of the American Journal of Respiratory and Critical Care Medicine.

“In virus-induced asthma there are different mechanisms operating than those described in allergen-induced asthma,” Gibson and colleagues write.

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Influence Of Viral Infection On Airway Microbiota And Epithelial Barrier Integrity

Respiratory viruses can also compromise the structural integrity of the epithelial barrier during their infective processes. In that respect, the replication of certain respiratory viruses in epithelial cells can induce loss of ciliated cells, which derives in morphological damages that can promote airway hyperresponsiveness and aggravation of asthmatic processes., Apoptotic mechanisms in the epithelial barrier induced in the host, which initially has the function of limiting viral spreading, can cause further damage to the structure of the airway epithelium. Scientific evidence has also shown that respiratory viruses can disrupt tight junctions in the epithelium, disturbing cell-to-cell connections with an increase in paracellular permeability., Furthermore, certain respiratory viruses also have the capacity to interfere with processes of repair and wound healing in the airway epithelium, which can further alter the integrity and homeostasis of the epithelial barrier.

Can A Virus Make Asthma Worse

Paediatrics for Primary Care (and anyone else): Why ...

Studies show that viral infections cause asthma symptoms to worsen. One of the most common triggers of an asthma attack is viral or bacterial infections, like a cold, flu, pneumonia, or sinus infection. When you are sick, your airways become inflamed and narrowedmaking it more challenging to take in air. Respiratory viruses often cause an increase in mucus, which can also make breathing difficult.

Shortness of breath is a symptom of COVID-19, and for people with asthma it can be even worse. People with asthma are at higher risk for severe illness if they catch the novel coronavirus, according to the Centers for Disease Control and Prevention , for many of the same reasons other respiratory illnesses exacerbate symptoms.

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Animal Housing And Care

All animals were purchased from Charles River Canada and housed in a level 3 bio-containment facility at the University of Alberta. Animals were received at 1 month of age. Each animal was housed individually in a sealed bio-containment cage with its own independent air circulation. Animals were assessed multiple times per day by facility staff to ensure animals did not demonstrate physical signs of pain or stress such as hair loss, irritability, lethargy, and weight loss. Cages were lined with pine shavings and assessed regularly for cage cleanings, and ensuring ample water and food was available to each animal.

Confirmation Of Immune Memory To Parainfluenza Virus

Lymphocytes from sensitized PIV infected animals cultured in vitro with a 1×104 TCID50/mL dose of PIV stock solution showed significant proliferation, compared to cells from non-infected age-matched control animals lacking immune memory . In addition, the data suggest that this response was due to specific memory to PIV, as lymphocytes from these animal groups did not show proliferation in response to an unrelated respiratory virus, Rhinovirus-16.]

Enriched lymphocyte cell cultures demonstrated virus specific proliferation when immune memory was present.

Animals re-infected with live PIV and inoculated with UV-inactivated PIV exhibited BrdU incorporation when exposed to PIV in-vitro . The level of proliferation was similar to the positive control stimulated with phytohemagglutinin , and all were significantly higher than the uninfected age matched controls . Exposure to a different virus, Rhinovirus type-16 , did not induce BrdU incorporation. Error bars represent SD.

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Can Current Therapeutic Regimens Prevent Virus

There is no doubt that the reductions observed in asthma morbidity and mortality observed over the last 20 years are the result of better therapeutic management; however, the real question is, are asthma therapeutics effective in virus-induced exacerbations? Large studies have shown that even low-dose inhaled corticosteroids reduce exacerbations and the risk of death from asthma . For example, in comparison to no treatment, 100 g budesonide twice daily resulted in a 60% reduced risk of having a severe exacerbation in the OPTIMA trial . The addition of a long-acting 2-agonist to ICS further reduces the frequency , severity and duration of exacerbations. Studies such as these were not designed to identify the cause of the exacerbation; however, as viruses are thought to cause 50% of all exacerbations, it is reasonable to assume that some reduction in the incidence of virus-induced exacerbations would occur. None of these studies specifically identified whether improved asthma management does one or more of the following: 1) reduces the rate of respiratory viral illnesses; 2) reduces the rate at which respiratory viral infections trigger a sequence of inflammatory events that will result in an exacerbation; or 3) reduces the severity of symptoms or lung function such that the episode does not require exacerbation-defining medical intervention.

Mast Cells And Basophils

Asthma and Viral-Induced Wheeze

Mast cells and basophils are important sources of inflammatory mediators, characteristic of allergic inflammation in asthma. Mast cell basal and stimulated histamine release increases after viral infection . Airway mast cell numbers are upregulated in a rat model of parainfluenza infection. Several viruses can enhance basophil IgE-mediated histamine release, but the role of this cell in human asthma is controversial.

Mast cells are also important sources of inflammatory mediators. Their function and localization suggest an early interaction with viruses. Leukotriene C4 is one of the major mediators responsible for the late phase of bronchospasm in asthma. During RSV infection increased levels of LTC4 were found in the nasopharyngeal secretions of infants . Levels correlated well with the symptoms of the disease and concentrations in infants presenting with bronchiolitis were five-fold higher than in those with only upper respiratory tract symptomatology. Cultured alveolar macrophages can be infected with parainfluenza virus and respond with an increase in arachidonic acid metabolism. Several of the products of this pathway are known inducers of airway constriction, including LTC4, LTD4, prostaglandin F2, and thromboxanes and/or stimulants of mucous secretion such as PGF2, LTB2 and 5-hydroxyeicosatetraenoic acid .

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The Difference Between Poorly Controlled Asthma And Asthma Exacerbations

The most commonly used definition of an asthma exacerbation requires not an event of a particular character but the management of it, whether that be hospitalisation, emergency room presentation or a course of oral corticosteroids . Such an exacerbation can be an extension of the pattern of disease in ongoing poor control or an independent event. It is clear that some patients have excellent current control of asthma with minimal or no symptoms, and yet have sudden and severe exacerbations. Viral infections have been implicated in such events. At the other extreme, some patients have unrecognised or ineffectively managed asthma, and have extreme variability in symptoms and lung function. In these cases, exacerbations may be recorded not necessarily for the deepest fluctuations in lung function or for specific patterns of asthma worsening, but for those occasions where medical advice was sought and treatment given.

One particularly challenging aspect of asthma exacerbations is the differentiation between inadequate treatment regimens leading to episodic symptomatic asthma and catastrophic failures in asthma control in response to various stimuli, i.e. an exacerbation.

Summary Of The Findings:

A total of 42 Original Articless addressing the identification of respiratory viruses during episodes of asthma exacerbation were selected, mostly cross-sectional studies. There was a wide variation in the methodology of the assessed studies, particularly in relation to the children’s age and methods of collection and viral detection. The results indicate that, in up to 92.2% of exacerbations, a viral agent was potentially the main triggering factor, and human rhinovirus was the most frequently identified factor. The pattern of viral circulation may have been responsible for the seasonality of exacerbations. The association between viral infections and allergic inflammation appears to be crucial for the clinical and functional uncontrolled asthma, but few studies have evaluated other triggering factors in association with viral infection.

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