Exacerbations of Asthma and Chronic Obstructive Pulmonary Disease (COPD): Focus on Virus Induced Exacerbations

Abstract

Asthma and chronic obstructive pulmonary disease (COPD) are the 2 most prevalent chronic airway diseases. Much of the morbidity, mortality and health care costs of the diseases are associated with acute exacerbations, which are episodes of increased symptoms and airflow obstruction. Over the last decade evidence has emerged implicating virus respiratory tract infections as a major cause of exacerbations of both asthma and COPD. Current therapies are not very effective in the prevention or treatment of virus-induced exacerbations and exacerbations are therefore a major unmet medical need. The development of new and novel treatments requires a better understanding of the molecular and cellular mechanisms linking virus infection with exacerbations of asthma and COPD. This article provides an overview of current knowledge regarding the mechanisms of virus-induced exacerbations in both asthma and COPD. It will also review existing treatments and future treatments that are in advanced stages of development.

Coxsackievirus mutants that can bypass host factor PI4KIIIβ and the need for high levels of PI4P lipids for replication

“…Examples of well-known enteroviruses are poliovirus (PV), the causative agent of paralytic poliomyelitis, and the human rhinoviruses (HRV), which can cause respiratory tract illnesses and exacerbations of asthma and chronic obstructive pulmonary disease (COPD) [1,2]. Other clinically important members are echoviruses and coxsackieviruses, which can cause acute clinical manifestations ranging from mild febrile illness to more severe conditions including fulminant sepsis in neonates, meningo-encephalitis, and pancreatitis [3].…”

Pathogen-directed Therapy in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

“…Influenza has major repercussions in patients with underlying lung disease (127). A number of agents with activity against this pathogen are licensed for use.…”

“…They reduce duration of fever and symptoms in patients by approximately 24 hours. Their high incidence of side effects in elderly patients and the rapid development of resistance during treatment have limited their use (127). Neuraminidase inhibitors, zanamivir and oseltamivir, are also available for clinical use.…”

Rhinovirus vaccination: the case against

“…In the last few decades, several studies have provided clear evidence for a major role of respiratory viruses in triggering exacerbations of obstructive lung diseases [2], and rhinoviruses have emerged as the most frequently identified viruses during such acute episodes [3,4]. Consequently, since it is now recognised that rhinovirus infection can lead not only to a mild and self-limiting disease of the upper airways (i.e.…”

“…Furthermore, apart from influenza virus infection and, probably, respiratory syncytial virus [7][8][9], we do not have effective and safe antiviral treatments against the most common respiratory viruses [2]. Prevention, using vaccination, has long been thought to be potentially the most effective way of controlling virus-induced diseases.…”