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Early-Life Viral Lower Respiratory Tract Infections and Their Impact on Childhood Asthma: Molecular Endotypes and

Sara Allaham¹, Shamsulmustafa Mohamed¹, Manal Yusuf¹

¹First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.

Pediatric Allergy, Immunology, and Pulmonology

|April 28, 2026

Insights

Early viral infections like respiratory syncytial virus (RSV) and human rhinovirus (HRV) in children significantly increase asthma risk. Prevention strategies targeting these infections are crucial for reducing childhood asthma globally.

Area of Science:

Pediatric respiratory health
Infectious disease epidemiology
Asthma pathogenesis

Background:

Early-life viral lower respiratory tract infections (LRTIs), especially RSV and HRV, are key drivers of pediatric morbidity and asthma development.
RSV causes substantial global childhood hospitalizations and deaths, with distinct age peaks for RSV and HRV.
Complex interactions involving viral injury, genetic factors (e.g., 17q21 variants), and environmental exposures contribute to increased asthma risk.

Purpose of the Study:

To review current evidence on the epidemiology, mechanisms, and long-term consequences of early-life viral LRTIs.
To explore the molecular and immunological factors underlying virus-induced asthma.
To discuss emerging diagnostic and preventive strategies for reducing the global burden of pediatric asthma.

Main Methods:

Comprehensive literature review of epidemiological data.
Analysis of mechanistic studies on viral LRTIs and asthma development.
Synthesis of information on genetic, epigenetic, and microbial influences.

Main Results:

Viral LRTIs are strongly associated with the development of childhood asthma through various pathways.
Identified molecular and immunological endotypes of virus-induced asthma.
Highlighted the role of genetic susceptibility, epigenetic modifications, and the microbiome.

Conclusions:

Early-life viral LRTIs represent a critical window for asthma prevention.
Emerging strategies including vaccines, monoclonal antibodies, and microbiome-targeted therapies show promise.
Integrated approaches are needed to mitigate the global impact of viral LRTIs on pediatric respiratory health.

Read full analysis

Abstract:

Background: Early-life viral lower respiratory tract infections (LRTIs), particularly those caused by respiratory syncytial virus (RSV) and human rhinovirus (HRV), are major contributors to pediatric morbidity and are strongly linked to asthma. RSV causes about 3.6 million hospitalizations and 100,000 deaths annually in children under 5, mainly in low- and middle-income countries. RSV peaks in infancy, while HRV has more impact later in childhood. Mechanisms include viral epithelial injury, genetic susceptibility (e.g., 17q21 variants), and environmental factors (e.g., allergic sensitization). Together, these raise asthma risk. Diagnosis is difficult due to overlapping presentations and reliance on molecular tests. Preventive strategies include maternal RSV vaccination, long-acting monoclonal antibodies such as nirsevimab and palivizumab, and pediatric vaccine candidates. Strategies to limit allergic sensitization may lower HRV-related asthma risk. Long-term effects include persistent wheeze and asthma, making early life a crucial window for prevention.Methods: This review summarizes current evidence on the epidemiology, mechanisms, and long-term impact of early viral LRTIs.Results: It highlights molecular and immunological endotypes of virus-induced asthma and explores the influence of genetic, epigenetic, and microbial factors. Emerging diagnostic tools and preventive strategies-including vaccines, monoclonal antibodies, environmental interventions, and microbiome-targeted therapies-are also discussed as means to reduce the global pediatric asthma burden and improve respiratory health.

Keywords:

childhood asthma human rhinovirus microbiome molecular endotypes respiratory syncytial virus viral lower respiratory tract infections

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