The role of infection in asthma is varied in that it may exacerbate established asthma or contribute to the initial development of the clinical onset of asthma. Mounting evidence implicates both roles, with particular viral pathogens, namely human rhinovirus (HRV) and respiratory syncytial virus (RSV), among the most likely culprits in asthma inception. Once asthma is present, infection, particularly viral infections, are a common precipitant of asthma exacerbations. Bacterial infections and colonization also have been associated with exacerbation and recurrent wheeze, an effect that may be independent or a cofactor with viruses. Atypical bacterial infections such as Mycoplasma pneumoniae and Chlamydia pneumoniae and fungi in the case of allergic bronchopulmonary aspergillosis (ABPA), also play a potential role in inducing and exacerbating this disease. Additionally, certain individuals may have a genetic predisposition toward viral induced wheezing and the development of asthma. This paper will discuss host and environmental factors, common pathogens, clinical characteristic, and genetic influences associated with infection related asthma.

Asthma is a multifaceted disease and is associated with significant impairment and risk, and a therapeutic response that is highly variable. While current treatments are usually effective for patients with mild to moderate disease, patients with more severe asthma are often unresponsive to current efforts, and there remains a need for agents with properties which may achieve control in these individuals. There is ongoing research to identify bioactive molecules that contribute to the pathophysiology of asthma, and many of these have been identified as potential therapeutic targets to improve control of this disease. As a consequence of these efforts, monoclonal antibodies have been developed and tested as to their effectiveness in the treatment of asthma. The assessment of these new treatments has identified particular pathways which, in selected patients, have shown benefit. The following review will discuss the current and future use of biological agents for the treatment of asthma, their efficacy, and how certain patient phenotypes and endotypes may be associated with biomarkers which may be used to select treatments to achieve greatest effectiveness of their use. As knowledge of the effects of these biological agents in asthma emerge, as well as the patients in whom they are most beneficial, the movement toward personalized treatment will follow.

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