Bakakos Agamemnon, Sotiropoulou Zoi, Vontetsianos Angelos, Zaneli Stavroula, Papaioannou Andriana I, Bakakos Petros
1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece.
J Asthma Allergy. 2023 Sep 26;16:1025-1040. doi: 10.2147/JAA.S277455. eCollection 2023.
Asthma is a common airway disease, affecting millions of people worldwide. Although most asthma patients experience mild symptoms, it is characterized by variable airflow limitation, which can occasionally become life threatening in the case of a severe exacerbation. The commonest triggers of asthma exacerbations in both children and adults are viral infections. In this review article, we will try to investigate the most common viruses triggering asthma exacerbations and their role in asthma immunopathogenesis, since viral infections in young adults are thought to trigger the development of asthma either right away after the infection or at a later stage of their life. The commonest viral pathogens associated with asthma include the respiratory syncytial virus, rhinoviruses, influenza and parainfluenza virus, metapneumovirus and coronaviruses. All these viruses exploit different molecular pathways to infiltrate the host. Asthmatics are more prone to severe viral infections due to their unique inflammatory response, which is mostly characterized by T2 cytokines. Unlike the normal T1 high response to viral infection, asthmatics with T2 high inflammation are less potent in containing a viral infection. Inhaled and/or systematic corticosteroids and bronchodilators remain the cornerstone of asthma exacerbation treatment, and although many targeted therapies which block molecules that viruses use to infect the host have been used in a laboratory level, none has been yet approved for clinical use. Nevertheless, further understanding of the unique pathway that each virus follows to infect an individual may be crucial in the development of targeted therapies for the commonest viral pathogens to effectively prevent asthma exacerbations. Finally, biologic therapies resulted in a complete change of scenery in the treatment of severe asthma, especially with a T2 high phenotype. All available data suggest that monoclonal antibodies are safe and able to drastically reduce the rate of viral asthma exacerbations.
哮喘是一种常见的气道疾病，全球数百万人受其影响。尽管大多数哮喘患者症状较轻，但它的特点是气流受限多变，在严重发作时偶尔会危及生命。儿童和成人哮喘发作最常见的诱因是病毒感染。在这篇综述文章中，我们将试图研究引发哮喘发作的最常见病毒及其在哮喘免疫发病机制中的作用，因为年轻人的病毒感染被认为要么在感染后立即引发哮喘，要么在其生命后期引发哮喘。与哮喘相关的最常见病毒病原体包括呼吸道合胞病毒、鼻病毒、流感和副流感病毒、偏肺病毒和冠状病毒。所有这些病毒利用不同的分子途径侵入宿主。哮喘患者由于其独特的炎症反应更容易发生严重的病毒感染，这种炎症反应主要以2型细胞因子为特征。与正常情况下对病毒感染的1型高反应不同，炎症以2型为主的哮喘患者在控制病毒感染方面能力较弱。吸入和/或全身用皮质类固醇及支气管扩张剂仍然是哮喘发作治疗的基石，尽管许多在实验室水平上使用的靶向疗法可阻断病毒用于感染宿主的分子，但尚无一种被批准用于临床。然而，进一步了解每种病毒感染个体所遵循的独特途径，对于开发针对最常见病毒病原体的靶向疗法以有效预防哮喘发作可能至关重要。最后，生物疗法彻底改变了重度哮喘的治疗局面，尤其是对于2型高表型的患者。所有现有数据表明，单克隆抗体是安全的，并且能够大幅降低病毒性哮喘发作的发生率。
