Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Clinical Reviews in Allergy & Immunology
Published in: Clinical Reviews in Allergy & Immunology 1/2015

01-02-2015

Infection in Severe Asthma Exacerbations and Critical Asthma Syndrome

Authors: Christian E. Sandrock, Andrew Norris

Published in: Clinical Reviews in Allergy & Immunology | Issue 1/2015

Login to get access

Abstract

In chronic persistent asthma and severe acute exacerbations of bronchial asthma, infectious agents are the predominant triggers that drive disease and airway pathobiology. In acute exacerbations of bronchial asthma (AEBA) including near fatal and fatal asthma, viral agents, particularly human rhinovirus-C, respiratory syncytial virus and influenza A appear to be the more prevalent and recurring threats. Both viral, and to a lesser extent bacterial agents, can play a role, and co-infection may also be present and worsen prognosis in hospitalized patients, placing a portion at risk for critical asthma syndrome. During severe acute exacerbations, infectious agents must be treated empirically, but the initial treatment regimens can vary and viral coverage may also vary based on seasonality and patient age. Early treatment with ceftriaxone and azithromycin, along with oseltamivir in winter months, should be initiated with all cases of severe exacerbations where infection is suspected, and definitely in critical asthma syndrome until infection is excluded by appropriate diagnostic testing. In this manuscript we will outline the impact of the major viral agents on severe asthma including the data from the 2009 H1N1 influenza pandemic. The role of bacterial infections in acute exacerbations of asthma will also be reviewed as well as the benefit of empiric antibiotics and the role of macrolides in both acute and chronic asthma.
Literature
1.
Monto AS, Sullivan KM (1993) Acute respiratory illness in the community. Frequency of illness and the agents involved. Epidemiol Infect 110(1):145–160PubMedCentralPubMedCrossRef
2.
3.
Johnston SL et al (1996) The relationship between upper respiratory infections and hospital admissions for asthma: a time-trend analysis. Am J Respir Crit Care Med 154(3 Pt 1):654–660PubMedCrossRef
4.
MacDowell AL, Bacharier LB (2005) Infectious triggers of asthma. Immunol Allergy Clin North Am 25(1):45–66PubMedCrossRef
5.
6.
Dales RE et al (1996) Respiratory infections and the autumn increase in asthma morbidity. Eur Respir J 9(1):72–77PubMedCrossRef
7.
Tan WC et al (2003) Epidemiology of respiratory viruses in patients hospitalized with near-fatal asthma, acute exacerbations of asthma, or chronic obstructive pulmonary disease. Am J Med 115(4):272–277PubMedCrossRef
8.
Corne JM et al (2002) Frequency, severity, and duration of rhinovirus infections in asthmatic and non-asthmatic individuals: a longitudinal cohort study. Lancet 359(9309):831–834PubMedCrossRef
9.
Wark PA et al (2005) Asthmatic bronchial epithelial cells have a deficient innate immune response to infection with rhinovirus. J Exp Med 201(6):937–947PubMedCentralPubMedCrossRef
10.
11.
Calhoun WJ et al (1991) Experimental rhinovirus 16 infection potentiates histamine release after antigen bronchoprovocation in allergic subjects. Am Rev Respir Dis 144(6):1267–1273PubMedCrossRef
12.
de Gouw HW et al (1998) Relationship between exhaled nitric oxide and airway hyperresponsiveness following experimental rhinovirus infection in asthmatic subjects. Eur Respir J 11(1):126–132PubMedCrossRef
13.
Sanders SP et al (2004) Role of nasal nitric oxide in the resolution of experimental rhinovirus infection. J Allergy Clin Immunol 113(4):697–702PubMedCrossRef
14.
Marshall JS, King CA, McCurdy JD (2003) Mast cell cytokine and chemokine responses to bacterial and viral infection. Curr Pharm Des 9(1):11–24PubMedCrossRef
15.
Jolly S, Detilleux J, Desmecht D (2004) Extensive mast cell degranulation in bovine respiratory syncytial virus-associated paroxystic respiratory distress syndrome. Vet Immunol Immunopathol 97(3–4):125–136PubMedCrossRef
16.
17.
Wang S et al (2010) Influenza virus-cytokine-protease cycle in the pathogenesis of vascular hyperpermeability in severe influenza. J Infect Dis 202(7):991–1001PubMedCrossRef
18.
19.
20.
21.
Atmar RL et al (1998) Respiratory tract viral infections in inner-city asthmatic adults. Arch Intern Med 158(22):2453–2459PubMedCrossRef
22.
23.
24.
25.
Cox DW et al (2013) HRV-C infection in young children with acute wheeze is associated with increased acute respiratory hospital admissions. Am J Respir Crit Care Med 188:1358–64PubMedCrossRef
26.
Grunberg K et al (2001) Rhinovirus-induced airway inflammation in asthma: effect of treatment with inhaled corticosteroids before and during experimental infection. Am J Respir Crit Care Med 164(10 Pt 1):1816–1822PubMedCrossRef
27.
Rakes GP et al (1999) Rhinovirus and respiratory syncytial virus in wheezing children requiring emergency care. IgE and eosinophil analyses. Am J Respir Crit Care Med 159(3):785–790PubMedCrossRef
28.
Teichtahl H, Buckmaster N, Pertnikovs E (1997) The incidence of respiratory tract infection in adults requiring hospitalization for asthma. Chest 112(3):591–596PubMedCrossRef
29.
Simpson JL et al (2003) Use of induced sputum for the diagnosis of influenza and infections in asthma: a comparison of diagnostic techniques. J Clin Virol 26(3):339–346PubMedCrossRef
30.
Falsey AR et al (2005) Respiratory syncytial virus infection in elderly and high-risk adults. N Engl J Med 352(17):1749–1759PubMedCrossRef
31.
Hayashi S, Hogg JC (2007) Adenovirus infections and lung disease. Curr Opin Pharmacol 7(3):237–243PubMedCrossRef
32.
Marin J et al (2000) Persistence of viruses in upper respiratory tract of children with asthma. J Infect 41(1):69–72PubMedCrossRef
33.
Macek V et al (1994) Persistent adenoviral infection and chronic airway obstruction in children. Am J Respir Crit Care Med 150(1):7–10PubMedCrossRef
34.
Papadopoulos NG et al (2011) Viruses and bacteria in acute asthma exacerbations—a GA(2) LEN-DARE systematic review. Allergy 66(4):458–468PubMedCrossRef
35.
Williams JV et al (2005) Human metapneumovirus infection plays an etiologic role in acute asthma exacerbations requiring hospitalization in adults. J Infect Dis 192(7):1149–1153PubMedCentralPubMedCrossRef
36.
Khetsuriani N et al (2007) Prevalence of viral respiratory tract infections in children with asthma. J Allergy Clin Immunol 119(2):314–321PubMedCrossRef
37.
Dao CN et al (2010) Adult hospitalizations for laboratory-positive influenza during the 2005–2006 through 2007–2008 seasons in the United States. J Infect Dis 202(6):881–888PubMedCrossRef
38.
39.
Skarbinski J et al (2011) Hospitalized patients with 2009 pandemic influenza A (H1N1) virus infection in the United States—September-October 2009. Clin Infect Dis 52(Suppl 1):S50–S59PubMedCrossRef
40.
Van Kerkhove MD et al (2011) Risk factors for severe outcomes following 2009 influenza A (H1N1) infection: a global pooled analysis. PLoS Med 8(7):e1001053PubMedCentralPubMedCrossRef
41.
Mortensen E. et al (2013) Epidemiology and outcomes of adults with asthma who were hospitalized or died with 2009 pandemic influenza A (H1N1)—California, 2009. Influenza Other Respi Viruses
42.
Jain S et al (2009) Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med 361(20):1935–1944PubMedCrossRef
43.
Lu PJ et al (2011) A Influenza (H1N1) 2009 monovalent vaccination among adults with asthma, U.S., 2010. Am J Prev Med 41(6):619–626PubMedCrossRef
44.
Cazzola M, Matera MG, Rossi F (1991) Bronchial hyperresponsiveness and bacterial respiratory infections. Clin Ther 13(1):157–171PubMed
45.
El Sayed Zaki M, Raafat D, El Metaal AA (2009) Relevance of serology for Mycoplasma pneumoniae diagnosis compared with PCR and culture in acute exacerbation of bronchial asthma. Am J Clin Pathol 131(1):74–80PubMedCrossRef
46.
Nagayama Y et al (2007) Bacterial colonization in respiratory secretions from acute and recurrent wheezing infants and children. Pediatr Allergy Immunol 18(2):110–117PubMedCrossRef
47.
48.
Talbot TR et al (2005) Asthma as a risk factor for invasive pneumococcal disease. N Engl J Med 352(20):2082–2090PubMedCrossRef
49.
Klemets P et al (2010) Risk of invasive pneumococcal infections among working age adults with asthma. Thorax 65(8):698–702PubMedCrossRef
50.
Essilfie AT et al (2012) Combined Haemophilus influenzae respiratory infection and allergic airways disease drives chronic infection and features of neutrophilic asthma. Thorax 67(7):588–599PubMedCrossRef
51.
Seddon PC et al (1992) Branhamella catarrhalis colonization in preschool asthmatics. Pediatr Pulmonol 13(3):133–135PubMedCrossRef
52.
Lehtinen P et al (2006) Bacterial coinfections in children with viral wheezing. Eur J Clin Microbiol Infect Dis 25(7):463–469PubMedCrossRef
53.
Lieberman D et al (2003) Atypical pathogen infection in adults with acute exacerbation of bronchial asthma. Am J Respir Crit Care Med 167(3):406–410PubMedCrossRef
54.
55.
Wark PA et al (2002) Chlamydia pneumoniae immunoglobulin A reactivation and airway inflammation in acute asthma. Eur Respir J 20(4):834–840PubMedCrossRef
56.
57.
Nagel G et al (2012) Association of pertussis and measles infections and immunizations with asthma and allergic sensitization in ISAAC Phase Two. Pediatr Allergy Immunol 23(8):737–746PubMedCrossRef
58.
Burgess JA et al (2012) Childhood infections and the risk of asthma: a longitudinal study over 37 years. Chest 142(3):647–654PubMedCrossRef
59.
Denning DW et al (2006) The link between fungi and severe asthma: a summary of the evidence. Eur Respir J 27(3):615–626PubMedCrossRef
60.
Targonski PV, Persky VW, Ramekrishnan V (1995) Effect of environmental molds on risk of death from asthma during the pollen season. J Allergy Clin Immunol 95(5 Pt 1):955–961PubMedCrossRef
61.
Jaakkola MS, Ieromnimon A, Jaakkola JJ (2006) Are atopy and specific IgE to mites and molds important for adult asthma? J Allergy Clin Immunol 117(3):642–648PubMedCrossRef
62.
Knutsen AP et al (2012) Fungi and allergic lower respiratory tract diseases. J Allergy Clin Immunol 129(2):280–291, quiz 292–3PubMedCrossRef
63.
Denning DW et al (2009) Randomized controlled trial of oral antifungal treatment for severe asthma with fungal sensitization: The Fungal Asthma Sensitization Trial (FAST) study. Am J Respir Crit Care Med 179(1):11–18PubMedCrossRef
64.
Crim C et al (2009) Pneumonia risk in COPD patients receiving inhaled corticosteroids alone or in combination: TORCH study results. Eur Respir J 34(3):641–647PubMedCrossRef
65.
Rodrigo GJ, Castro-Rodriguez JA, Plaza V (2009) Safety and efficacy of combined long-acting beta-agonists and inhaled corticosteroids vs long-acting beta-agonists monotherapy for stable COPD: a systematic review. Chest 136(4):1029–1038PubMedCrossRef
66.
McKeever T et al (2013) Inhaled corticosteroids and the risk of pneumonia in people with asthma: a case control study. Chest 144:1788–1794PubMedCrossRef
67.
Graham VA et al (1982) Routine antibiotics in hospital management of acute asthma. Lancet 1(8269):418–420PubMedCrossRef
68.
Shapiro GG et al (1974) Double-blind study of the effectiveness of a broad spectrum antibiotic in status asthmaticus. Pediatrics 53(6):867–872PubMed
69.
Koutsoubari I et al (2012) Effect of clarithromycin on acute asthma exacerbations in children: an open randomized study. Pediatr Allergy Immunol 23(4):385–390PubMedCrossRef
70.
Johnston SL et al (2006) The effect of telithromycin in acute exacerbations of asthma. N Engl J Med 354(15):1589–1600PubMedCrossRef
71.
Richeldi L et al (2005) Macrolides for chronic asthma. Cochrane Database Syst Rev 4:CD002997PubMed
72.
Brusselle GG et al (2013) Azithromycin for prevention of exacerbations in severe asthma (AZISAST): a multicentre randomised double-blind placebo-controlled trial. Thorax 68(4):322–329PubMedCrossRef
Metadata
Title
Infection in Severe Asthma Exacerbations and Critical Asthma Syndrome
Authors
Christian E. Sandrock
Andrew Norris
Publication date
01-02-2015
Publisher
Springer US
Published in
Clinical Reviews in Allergy & Immunology / Issue 1/2015
Print ISSN: 1080-0549
Electronic ISSN: 1559-0267
DOI
https://doi.org/10.1007/s12016-014-8435-x

Other articles of this Issue 1/2015

Clinical Reviews in Allergy & Immunology 1/2015 Go to the issue

ReviewPaper

Definition of Critical Asthma Syndromes

ReviewPaper

Pharmacotherapy of Critical Asthma Syndrome: Current and Emerging Therapies

ReviewPaper

Critical Asthma Syndrome in the ICU

ReviewPaper

Immunobiology of the Critical Asthma Syndrome

ReviewPaper

Management of Critical Asthma Syndrome During Pregnancy

ReviewPaper

The Acute Management of Asthma
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits