BP006 Bachelor of Biomedical Science

Introduction

Asthma is a condition that affects the respiratory system whereby the airway becomes inflamed, swells, and narrows whilst producing excess mucus making it difficult to breathe. This condition can be acute or chronic that can even alter the daily routine activities of an individual or even death. There are three types of asthma; nocturnal asthma, exercise-induced asthma, allergic asthma, occupational and cough variant asthma.  However, this asthma can be exercabated by viruses that infect the respiratory system which is linked to flu and common cold triggering more than 50% of acute asthma. These viruses tend to trigger immune responses causing inflammation and hyperresponsiveness of the respiratory tract. Furthermore, their effect can be amplified in the presence of an allergen that dampens the immune system. This paper will therefore explore symptoms, the causes, diagnosis and treatment, and prevention.

Symptoms

The symptoms usually prompt in adulthood and mostly, a person who is having viral exercabated asthma could have had asthma in childhood that emerged after disappearing. Furthermore, it can also occur to people diagnosed with asthma both children and adult including who control the condition well. The symptoms of this type of asthma have no difference to other types of asthma, however, according to Steinke and Borish 2016, these symptoms can be severe due to the re-occurrence of the infection mostly to poor controlling of the condition and smoking individuals. The common symptoms are chest tightness, coughing, wheezing, dyspnea, chills and fever, fatigue, nasal congestion, sinus pain, headache, sneezing, runny nose, and loss of appetite. According to Backman et. al., 2018, the cases that occur in an adult are difficult to handle since they are persistent and difficult to control with a declining functioning of lungs that happens rapidly thus increasing susceptibility to infection. Furthermore, these infections include recurrent respiratory infections which when lower respiratory infections are prolonged, asthma management can become more difficult causing severe attacks of asthma while pneumonia can result in people who use corticosteroid inhalers due to the immune suppress properties of the drug.

Causes

Viral-induced asthma is associated with certain viruses which infect the respiratory system and are linked to causing a new onset or exercabate acute of the disease. These viruses include; influenza virus especially type A, rhinovirus, enterovirus 68, pneumonia virus, human bocavirus, parainfluenza virus, coronavirus, adenovirus, and respiratory syncytial virus. According to Kennedy, Pham, and Borish 2019, the rhinovirus causes 60-70% of the total cases of viral-induced asthma while the rest are linked to respiratory syncytial virus and influenza virus. However, there is little literature showing how different infections caused by viruses can trigger asthma. Different hypotheses explain the etiology of viral-induced asthma that include; early respiratory infection with lower respiratory tract involvement and allergy-induced inflammation.

Early respiratory infection with lower respiratory tract involvement

According to research by Abe et. al., 2019, most of these respiratory viruses have been found mostly in hospitalized patients for life-threatening and acute non-life-threatening asthma. Among these patients, rhinovirus has been seen to be the most common virus while other viruses may cause co-infection that is crucial. Besides, asthmatic patients are at less risk of upper respiratory infections than non-asthmatic people but may have severe consequences of lower respiratory infections sufferings. Asthmatic people can have their condition exercabated and the time of symptoms of lower respiratory tract upon rhinovirus infection. The early induced apoptosis that stops the replication of a virus in asthmatic people was impaired. However, treating airway allergic inflammation may reduce the severity and frequency of rhinovirus-triggered symptoms.  According to Van Meel et. al., 2018, there is an increased risk of asthma to people who have had an infection of the lower respiratory tract and if it was severe and exposure to an allergen during their early life. Furthermore, there has been an appearance of atopy-associated mechanism in acute viral exercabated asthma especially after the clearance of the virus and pronged symptoms. According to Efthimiou, Poll, and Barnes, 2019, the relationship between viral infection and asthma can be prevented by coming up with strategies that aim at inhibiting the effectors related to atopy mechanisms from involving in viral infection of respiratory system response by the host since these diseases are the dominant causes of deaths and morbidities.

The recent epidemiology study suggests that respiratory infections are the cause of acute asthmatic attacks in children accounting for 80 to 85%. According to Scheltema et. al., 2018, the parainfluenza and respiratory syncytial virus have been found in infants, while mycoplasma and rhinovirus have been seen to be more common in children. In asthmatic children, they should be vaccinated against the influenza virus, they should use the inhaled anti-inflammatory drugs in the management of moderate and severe asthmatic attacks before the viral epidemic period and provide education to the family and the child on when to seek medical attention.

Allergen induced inflammation

Recent studies done by Lynch et. al., 2016, have demonstrated a suggestion that the synergistic interaction of viruses with air pollution and allergens can provoke an asthmatic attack. A rhinovirus immunity if it has been impaired can cause the virus to be less cleared thus making the symptoms prolong. According to Persson et. al., 2016, these infections exercabate asthma by provoking Th-type 2 cells recruitment in the lungs thus may be the cause of the inflammation, epithelial cell damage, and airway hyper-responsiveness. The current studies suggest that viral-induced asthma may be caused by several factors such as early life exposure to respiratory viruses, genetic predisposition to asthma, concurrent allergies, and delayed immune system maturation. According to Murrison et. al., 2016, the exercabation of asthma and wheezing is associated with allergens and viral infection. In few years of development, if one is exposed to aeroallergens poses a great risk towards asthma, since it is directly related to immunoglobulin E. By the age of 2 years, the persistent wheezing risks were associated with early allergen exposure and viral infections of the lower respiratory tract. Besides, in a study done by Ornelas, 2018, early adulthood respiratory tract hyper-responsiveness had higher levels of immunoglobulin E compared to people with normal lifelong responsiveness. This phenomenon is related to the wheezing and allergic exposure during childhood that also had higher immunoglobulin E levels.

Moreover, there is a concern on asthmatic people during this pandemic of COVID 19. According to Abrams, W‘t Jong, and Yang, 2020, it is a special concern because; an asthmatic person can be seriously ill in case of COVID 19 infection, these people may find it difficult to differentiate between asthma and the COVID 19 and during the cold and flu season, a mix of a fast-spreading virus can make the person have asthmatic aggravating factors. Therefore, asthmatic people should be tested in case they are having the symptoms and take precautions.

Diagnosis

This type of asthma mostly is identified by the classic asthma symptoms development such as bronchoconstriction which occurs alongside bronchospasms accompanied with the symptoms of lower respiratory infection. Besides, for people who have been controlling asthma well, the appearance of asthmatic symptoms can suggest viral-induced asthma. According to McCracken et. al., 2017, people with viral exercabated asthma will express a reduction in lung functionality during spirometry tests and other pulmonary function tests. In case of a suspicion of pneumonia, a chest X-ray can be ordered however, in diagnosing asthma it is limiting. Furthermore, the blood oxygen levels are also important in diagnosing asthma thus pulse oximeter can be used.

Treatment

Viral-induced asthma has no treatment. However, it can be managed by the treatments that are used for exercabation of asthma such as inhaled bronchodilators, antivirals, corticosteroids, antibiotics, oxygen therapy, and epinephrine. Currently, there is no known medication for viral-induced asthma thus necessitating a need to prevent it before happening. According to Papadopoulos et. al., 2017, these preventive measures include; handwashing with soap frequently, getting a flu shot annually, avoid touching eyes, mouth and nose and avoid people with cold, flu, or other respiratory infections and triggers. Furthermore, the underlying virus may be treated by having enough sleep, taking enough fluids, monitoring peak flow, and taking antivirals when need be.

Conclusion

In a nutshell, there is no medication to treat viral-induced asthma therefore there is a need to prevent ourselves before the attack. The rhinovirus has been seen to be the most common virus that is linked to viral-induced asthma compared to the rest of the respiratory viruses. Therefore, measures have to be put in place since these types of asthma are the leading causes of mortality and morbidity.

Reference list

Steinke, J.W. and Borish, L., 2016. Immune responses in rhinovirus-induced asthma exacerbations. Current Allergy and asthma reports, 16(11), pp.1-8.

Abrams, E.M., W‘t Jong, G. and Yang, C.L., 2020. Asthma and COVID-19. CMAJ, 192(20), pp.E551-E551.

McCracken, J.L., Veeranki, S.P., Ameredes, B.T. and Calhoun, W.J., 2017. Diagnosis and management of asthma in adults: a review. Jama, 318(3), pp.279-290.

Backman, K., Ollikainen, H., Piippo‐Savolainen, E., Nuolivirta, K. and Korppi, M., 2018. Asthma and lung function in adulthood after a viral wheezing episode in early childhood. Clinical & Experimental Allergy, 48(2), pp.138-146.

Kennedy, J.L., Pham, S. and Borish, L., 2019. Rhinovirus and asthma exacerbations. Immunology and allergy clinics of North America, 39(3), p.335.

Abe, N., Yasudo, H., Fukano, R., Nakamura, T., Okada, S., Wakiguchi, H., Okazaki, F., Shirabe, K., Toda, S., Okamoto, R. and Ouchi, K., 2019. Multi‐season analyses of causative pathogens in children hospitalized with asthma exacerbation. Pediatric Allergy and Immunology, 30(7), pp.724-731.

Van Meel, E.R., Den Dekker, H.T., Elbert, N.J., Jansen, P.W., Moll, H.A., Reiss, I.K., De Jongste, J.C., Jaddoe, V.W. and Duijts, L., 2018. A population-based prospective cohort study examining the influence of early-life respiratory tract infections on school-age lung function and asthma. Thorax, 73(2), pp.167-173.

Efthimiou, J., Poll, C. and Barnes, P.J., 2019. Dual mechanism of action of T2 inhibitor therapies in virally induced exacerbations of asthma: evidence for a beneficial counter-regulation. European Respiratory Journal, 54(1).

Scheltema, N.M., Nibbelke, E.E., Pouw, J., Blanken, M.O., Rovers, M.M., Naaktgeboren, C.A., Mazur, N.I., Wildenbeest, J.G., van der Ent, C.K. and Bont, L.J., 2018. Respiratory syncytial virus prevention and asthma in healthy preterm infants: a randomized controlled trial. The Lancet Respiratory Medicine, 6(4), pp.257-264.

Murrison, L.B., Brandt, E.B., Myers, J.B. and Hershey, G.K.K., 2019. Environmental exposures and mechanisms in allergy and asthma development. The Journal of clinical investigation, 129(4), pp.1504-1515.

Lynch, J.P., Werder, R.B., Simpson, J., Loh, Z., Zhang, V., Haque, A., Spann, K., Sly, P.D., Mazzone, S.B., Upham, J.W. and Phipps, S., 2016. Aeroallergen-induced IL-33 predisposes to the respiratory virus–induced asthma by dampening antiviral immunity. Journal of Allergy and Clinical Immunology, 138(5), pp.1326-1337.

Papadopoulos, N.G., Megremis, S., Kitsioulis, N.A., Vangelatou, O., West, P. and Xepapadaki, P., 2017. Promising approaches for the treatment and prevention of viral respiratory illnesses. Journal of Allergy and Clinical Immunology, 140(4), pp.921-932.

Persson, I.M., Akbarshahi, H., Menzel, M., Brandelius, A. and Uller, L., 2016. Increased expression of upstream TH 2-cytokines in a mouse model of viral-induced asthma exacerbation. Journal of translational medicine, 14(1), pp.1-12.

Ornelas, M.D.L.J., 2018. Most commonly isolated viruses in asthma exacerbation and their correlation with eosinophil and total serum immunoglobulin E levels. Arch Argent Pediatr, 116(3), pp.192-197.

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