Reviews and feature article
Asthma exacerbations: Origin, effect, and prevention

https://doi.org/10.1016/j.jaci.2011.10.024Get rights and content

Asthma is the most common chronic respiratory disease, affecting up to 10% of adults and 30% of children in the Western world. Despite advances in asthma management, acute exacerbations continue to occur and impose considerable morbidity on patients and constitute a major burden on health care resources. Respiratory tract viruses have emerged as the most frequent triggers for exacerbations in both children and adults; however, the mechanisms underlying these remain poorly understood. More recently, it has become increasingly clear that interactions might exist between viruses and other triggers, increasing the likelihood of an exacerbation. In this article we begin with an overview of the health, economic, and social burden that exacerbations of asthma carry with them. This is followed by a review of the pathogenesis of asthma exacerbations, highlighting the various triggers responsible and multiple interactions that exist between them. The final section first addresses what preventative measures are currently available for asthma exacerbations and subsequently examines which of the new treatments in development might lessen the burden of exacerbations in the future.

Key words

Asthma
asthma exacerbations
viral infection
virus
allergy
allergen
pollutant
bacteria

Abbreviations used

ACQ
Asthma Control Questionnaire
BEC
Bronchial epithelial cell
ICS
Inhaled corticosteroid
LABA
Long-acting β-agonist
NO2
Nitrogen dioxide
PEF
Peak expiratory flow
RSV
Respiratory syncytial virus
TLR
Toll-like receptor

Cited by (0)

Supported in part by MRC project grant G0601236, MRC Centre grant G1000758, the Predicta FP7 Collaborative Project grant 260895, and the Wellcome Trust–sponsored Centre for Respiratory Infection (CRI). D.J.J. is supported by ERC FP7 Advanced grant 233015 (to S.L.J.), A.S. is supported by an MRC Clinical Training Fellowship, A.S. and P.M. are National Institutes of Health Research Clinical Lecturers, and S.L.J. holds the Asthma UK Clinical Chair (CH1155).

Disclosure of potential conflict of interest: S. L. Johnston is a consultant for AstraZeneca, Centocor, and Sanofi-Pasteur; is a consultant for and shareholder in Synairgen; has received research support from the European Research Council, Medical Research Council Clinical Training Fellowship, National Institutes of Health Research, Asthma UK, Medical Research Council, Predicta FP7 Collaborative Project, and the Wellcome Trust–sponsored Centre for Respiratory Infection. The rest of the authors declare that they have no relevant conflicts of interest.

View Abstract