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Grand Rounds |

Virus-Induced Asthma Attacks

David B. Jacoby, MD
JAMA. 2002;287(6):755-761. doi:10.1001/jama.287.6.755.
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Viral respiratory tract infections are a common cause of asthma attacks. Study of this phenomenon has revealed multiple mechanisms and contributed to understanding of the increase in airway inflammation and bronchoconstriction observed in this context. Changes in the neural control of the airways contribute to bronchoconstriction, which is reflected in an increased efficacy of anticholinergic medications during acute asthma attacks. The ability to prevent or treat viral respiratory tract infections is currently limited. However, as more effective antiviral treatments and vaccines become available, such therapies are likely to be effective in patients with asthma. Clinical management of this problem is illustrated in this article by the case of a 40-year-old woman with history of mild asthma who was admitted to an intensive care unit with severe bronchospasm and an upper respiratory tract infection.

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Figure 1. Viruses Detected During Respiratory Symptom and Peak Expiratory Flow Episodes
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Data from Johnston et al.2 RSV indicates respiratory syncytial virus.
Figure 2. Virus-Induced M2 Receptor Dysfunction
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Acetylcholine (ACh) released from parasympathetic nerve endings in the lungs constricts airways by binding to M3 muscarinic receptors on the airway smooth muscle. At the same time, ACh feeds back onto inhibitory M2 receptors on the nerve, turning off further release of ACh. Dysfunction of the M2 receptor increases the release of ACh and potentiates vagally mediated reflex bronchoconstriction.
Figure 3. Eosinophils Clustered Around Airway Nerves in Fatal Asthma
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Histologic sections from the airways of patients who died of acute asthma. Sections are stained with antibody to the nerve-specific protein PGP9.5, showing nerves in black, and with antibody to eosinophil major basic protein (red). A, Longitudinal section of nerve fibers (arrowhead) in the smooth muscle layer of the airway with eosinophils along the nerve fibers (original magnification, approximately ×1000). B, Cross-section of bundle of nerve fibers, with eosinophils surrounding the bundle. Note extracellular major basic protein deposited on the nerve (arrowhead) (original magnification, approximately ×400). Reproduced with permission.56

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