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The role of infection in asthma: implications for antibiotic therapy
Insights
Infant respiratory infections like bronchiolitis may lead to later-life asthma. Identifying atopic individuals and those with a family history of asthma is crucial for early intervention.
Area of Science:
- Pediatric respiratory medicine
- Immunology
- Epidemiology
Background:
- Infant respiratory infections, particularly bronchiolitis, are linked to recurrent wheezing and adult asthma.
- Atopic individuals and those with a family history of asthma are at higher risk for chronic airway dysfunction.
- Parenteral smoking is an additional risk marker for susceptible patients.
Purpose of the Study:
- To review the association between respiratory infections and the development of asthma.
- To identify risk factors for chronic airway dysfunction.
- To discuss the role of viral and bacterial infections in asthma exacerbations.
Main Methods:
- Literature review of studies on respiratory infections and asthma.
- Analysis of risk factors including atopy, family history, and smoking.
- Evaluation of the role of viral versus bacterial pathogens.
Main Results:
- Early-life respiratory infections are associated with increased risk of asthma.
- Atopy and family history are significant predictors of chronic airway dysfunction.
- Viral infections are primary triggers for asthma exacerbations in children and adults.
Conclusions:
- While a direct causal link remains speculative, early respiratory infections are a significant risk factor for asthma.
- Early identification of high-risk individuals (atopic, family history) is essential.
- Antibiotic use is not routinely warranted for respiratory infections without evidence of bacterial infection.
Abstract:
Respiratory infection, most prominently bronchiolitis, contracted in infancy is frequently associated with recurrent wheezing episodes and asthma in later life. Atopic individuals and those with a family history of allergy or asthma in first-degree relatives are especially susceptible to the development of chronic airway dysfunction and should be identified early. It is also noteworthy that parenteral cigarette smoking may serve as an additional marker of the high-risk patient. Respiratory infection affecting older children and adults is more commonly due to rhinovirus and influenza A and may cause a transient hyperreactivity to bronchoconstrictor agonists, but does not cause persistent dysfunction. The mechanism(s) by which antecedent respiratory infection is related to recurrent wheezing and asthma remain speculative, and at present a direct causal relationship cannot be established with certainty. Infectious respiratory disorders are also a cause of exacerbations of asthma in adults but more commonly in children, and these also are primarily viral in origin. Consequently, in the absence of clear evidence of bacterial infection, routine antibiotic use in this setting is unwarranted.