de Blic J, Brouard J, Vabret A, Deschildre A
Service de pneumologie et allergologie pédiatriques, hôpital universitaire Necker-Enfants-Malades, université Paris Descartes, Assistance publique des Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France.
EA 4655 U2RM, UCBN, service de pédiatrie médicale, CHU de Caen, avenue Côte-de-Nacre, 14032 Caen, France.
Rev Mal Respir. 2017 Feb;34(2):134-146. doi: 10.1016/j.rmr.2016.02.012. Epub 2017 Mar 3.
The spectrum of respiratory viruses is expanding and emerging diseases have been described regularly over the last fifteen years. The origin of these emerging respiratory viruses may be zoonotic (by crossing species barrier, after changes to RNA viruses such as avian influenza virus type A or coronaviruses), or related to the use of new identification techniques (metapneumovirus, bocavirus). The relationship between bronchiolitis and asthma is now better understood thanks to prospective follow up of birth cohorts. The role of rhinovirus has become predominant with respect to respiratory syncytial virus. The identification of predisposing factors immunological, functional, atopic and genetic, for the onset of asthma after rhinovirus infection suggests that viral infection reveals a predisposition rather than itself being a cause of asthma. The role of bacteria in the natural history of asthma is also beginning to be better understood. The results of the COPSAC Danish cohort have shown the frequency of bacterial identification during wheezy episodes before 3 years, and the impact of bacterial colonization at the age of one month on the onset of asthma by age 5 years. The role of bacterial infections in severe asthma in young children is also discussed.
在过去的十五年间，呼吸道病毒的种类不断增加，新出现的疾病也时有报道。这些新出现的呼吸道病毒的起源可能是人畜共患的（通过跨越物种屏障，在甲型禽流感病毒或冠状病毒等RNA病毒发生变异之后），或者与新的鉴定技术的应用有关（如偏肺病毒、博卡病毒）。由于对出生队列进行了前瞻性随访研究，细支气管炎与哮喘之间的关系如今已得到了更深入的了解。在呼吸道合胞病毒方面，鼻病毒的作用已变得更加突出。对感染鼻病毒后引发哮喘的免疫、功能、特应性和遗传等易感因素的鉴定表明，病毒感染揭示了一种易感性，而不是引发哮喘的原因。细菌在哮喘自然病程中的作用也开始得到更好的理解。丹麦COPSAC队列研究的结果显示了3岁前喘息发作期间细菌鉴定的频率，以及1个月大时细菌定植对5岁时哮喘发病的影响。同时也讨论了细菌感染在幼儿重症哮喘中的作用。
