Asthma during the first years of life and its relation to viral infections
Reference of this article: Gómez Carrasco JÁ. Asthma during the first years of life and its relation to viral infections. Rev Pediatr Aten Primaria. 2006;8:453-75.
Published in Internet: 30-09-2006
The biggest risk for the appearance of episodes of wheezing in infants and children comes
from the infections by respiratory viruses. The viruses most frequently responsible of wheezing
in this group are the respiratory syncytial virus (RSV) and the human metapneumovirus. In
school aged children and teenagers the rhinoviruses have the main role.
The bronchiolitis (BQL) by RSV is cause of hospitalization in 1-2% of children younger
than two in each autumn and winter season. Its clinical expression is very different and probably
related with genetic factors and the neurological and immune response in mucosal airway
of the affected kid.
The BQL clinically important is associated with wheezing and asthma during the following
years. In the BQL and later recurrent wheezing an incremented production of leukotrienes has
been demonstrated. Molecules able to avoid its liberation or to neutralise its effects can have
good effects in the asthma after the bronchiolitis, started most of the time by viruses.
In the handling of the asthma leaded by viruses in infants and preschoolers, inhaled corticosteroids
have demonstrated effectiveness limited to the active course period, but they can have some
repercussions in the growth of the affected kid. The idea of being able to modify the natural
course of the illness with the early establishment of breathed steroids has not been confirmed
with the studies now available. Montelukast, a receptor antagonist of leukotrienes, has demonstrated
a partial control of the symptoms that frequently remain after the bronchiolitis by RSV. The
use of this medicine in the recurrent wheezing in infants and preschoolers has demonstrated clinical
benefits without any significant adverse effects. Influenza immunization in children at risk and
a good control of the asthmatic illness are good strategies, with the aim of facing better conditions
in the winter season when respiratory infections origin numerous acute asthmatic exacerbations.
Our knowledge of asthma relapses is incomplete, because of the difficulties to understand
the interactions between the different starting agents (viruses, allergens, pollution, weather)
but to deepen in it will give chances for the therapeutic intervention.
Keywords● Antileukotrienes ● Asthma ● Asthmatic relapses ● Bronchiolitis ● Human metapneumovirus ● Inhaled corticosteroids ● Montelukast ● Syncytial virus ● Wheezing