Viral infections are the most frequent triggers of wheeze and asthma and yet their role in the development of symptoms remains controversial. Pre-existing airway abnormalities contribute to early virus-induced symptoms which usually remit in early childhood, whereas an interaction with airway inflammation causes exacerbations in asthma. However, the distinction between these two groups and the reason why some but not other children wheeze with viral infections is still debated. The effect of early infections on the developing immune system is also complex. The successful maturation of the T-cell response from a predominantly type 2 (atopic predisposition) at birth to a predominantly type 1 (optimal viral immunity) response, is influenced by genetic factors and the number of infections, as both are known to affect outcome. The relative parts played by predisposition and immunomodulation by early infections in later development of asthma are still controversial. These contentions are gradually being resolved by detailed prospective studies.
Virus infections, wheeze and asthma