Mechanisms of asthma exacerbations

Résumé fourni par la source

Asthma exacerbations are an important public health issue with high morbidity and mortality. Most are caused by respiratory viral infections (largely rhinoviruses), although allergens and bacteria can also trigger exacerbations, both independently and in concert with viruses. Many people with asthma have deficient antiviral immunity, in part as a result of excess of IgE, eosinophils and the type 2 cytokines IL-4, IL-5 and IL-13. This leads to failure to control early viral replication, increased virus loads, and consequently, virus-load-driven increased type 2 and pro-inflammatory immune responses, as well as excess mucus production/secretion. β2-agonist overuse without ICS use is a risk factor for exacerbations, likely because ICS protect against the adverse effects of β2-agonists in addition to their anti-inflammatory prophylactic properties. There are multiple existing and potential therapeutic agents to prevent or treat exacerbations, including antiviral, anti-bacterial and immunomodulatory therapies. Further research is needed to better prevent and treat exacerbations. Cite as: Fiorenzo E, Senior P, Farne H, et al. Mechanisms of asthma exacerbations. In: Jackson DJ, McDonald VM, Pavord ID, eds. Asthma (ERS Monograph). Sheffield, European Respiratory Society, 2025; pp. 67–84 [ https://doi.org/10.1183/2312508X.10013324 ].

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