22May

What is the connection between RSV and asthma?

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Respiratory syncytial virus (RSV) is a common virus that can affect the lungs. Having an RSV infection early in life can increase the risk of developing asthma. Additionally, an RSV infection can also worsen symptoms of asthma.

RSV is the leading cause of lower respiratory tract infections in infants and children worldwide. Nearly all children in the United States will experience an RSV infection before their second birthday.

Asthma is a common long-term inflammatory disease of the lungs that doctors characterize by the narrowing and swelling of the airways. It is still unclear what causes its development, but it likely occurs due to a combination of genetic and environmental factors.

Numerous studies suggest that infants requiring hospitalization for severe RSV infection early in life are at an increased risk of developing asthma or chronic wheezing later in childhood.

In this article, we will explore the relationship between RSV and asthma and how one affects the other.

Viral infections, such as RSV, adenovirus, and coronavirus, can cause the inception and worsening of asthma through different methods, including:

  • increased serum immunoglobulin E levels
  • epithelial (skin) damage or activation
  • decreased antiviral responses
  • changing host immune responses
  • promotion of respiratory tract inflammation
  • infection of the lower respiratory tract

A 2023 study indicates that an early RSV infection has links to a significantly increased risk of asthma in children. Evidence suggests that RSV infections can alter the metabolism of the developing airway cells of infants and young children. These changes can alter the barrier function, which predisposes the child to allergen desensitization.

Allergen sensitization is a significant risk factor relating to asthma inception, and severe RSV infection may contribute to the development of asthma through sensitivity to common allergens.

Several studies show an association between severe RSV bronchiolitis and the subsequent development of recurrent wheezing and asthma later in childhood. In a 2021 Chinese study, over one-third of infants and children with bronchiolitis secondary to an RSV infection had recurrent wheezing and asthma.

Similarly, those receiving hospitalization for RSV before the age of 2 years were more likely to develop asthma by the age of 18 years. They also have a three-fold risk of asthma hospitalizations and a two-fold higher risk of asthma medication use.

People with asthma may have more severe symptoms if they acquire an RSV infection. Evidence also notes that an RSV infection can worsen chronic health problems, such as asthma. For example, a person living with asthma may experience asthma attacks due to these infections.

Evidence notes that typically, infants, young children, and older adults are at a higher risk of severe RSV infections. According to the Asthma and Allergy Foundation of America, the following groups of people are more likely to get severe complications from RSV:

  • young infants aged 6 months and younger
  • premature infants
  • children younger than 2 with chronic diseases present at birth
  • children with neuromuscular disorders, including those with difficulty swallowing and clearing mucus
  • children with Down syndrome
  • older adults aged 65 years and older
  • adults with chronic heart or lung disease, such as those with asthma, emphysema, and chronic obstructive pulmonary disease
  • adults living in high altitudes
  • adults with weak immune systems or immune problems

In most cases, an individual with an RSV infection will show symptoms within 4–6 days after acquiring the virus. Common symptoms of an RSV infection include:

  • runny nose
  • decrease in appetite
  • coughing
  • sneezing
  • fever
  • wheezing

Apnea may be the initial symptom in infants younger than 6 months. Severe cases may present with the following symptoms:

To help relieve symptoms of an RSV infection, healthcare experts advise taking fever reducers, pain relievers, and drinking plenty of fluids. These can help manage fever and pain and help prevent dehydration. Before giving nonprescription cold medicines to a child, a parent or caregiver should talk with a doctor.

However, severe cases may require breathing support ranging from a high-flow nasal cannula to mechanical ventilation. As such, individuals at risk for moderate to severe disease may need hospital attention to receive adequate support.

Currently, there is no specific treatment for an RSV infection, although work is ongoing to develop vaccines and antiviral medications. An antiviral drug called ribavirin may have some activity against RSV. However, doctors no longer recommend it, except for people with severe immune system issues.

RSV infections and asthma can both affect the lungs. Having asthma puts a person at a higher risk of getting a severe RSV infection. Furthermore, those with asthma who acquire an RSV infection tend to experience worsening symptoms of asthma.

Additionally, research suggests that getting an RSV infection during early childhood can increase the risk of developing asthma later in life.

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