Большинство пациентов, страдающих бронхиальной астмой, достигают контроля заболевания в результате терапии ингаляционными кортикостероидами и b2-агонистами, однако эти препараты могут быть недостаточно эффективными в терапии вирусиндуцированных обострений астмы. Респираторные вирусные инфекции являются наиболее частой причиной развития бронхообструктивного синдрома у маленьких детей и наиболее частыми триггерами обострений астмы у детей, подростков и взрослых. В настоящей статье рассматриваются взаимосвязь респираторных вирусов и аллергенов, причины развития вирусиндуцированных обострений бронхиальной астмы, а также роль антилейкотриеновых препаратов в терапии астмы и профилактике вирусиндуцированных обострений.
Most patients suffering from bronchial asthma achieved disease control as a result of therapy with inhaled corticosteroids and b2-agonists, but these drugs may be ineffective in the treatment of virus-induced asthma exacerbations. Respiratory viral infections are the most common cause of broncho-obstructive syndrome in young children and the most frequent triggers of asthmatic exacerbations in children, adolescents and adults. This article discusses the relationship of respiratory viruses and allergens, causes of virus-induced asthma exacerbations, as well as the role of antileukotriene drugs in the treatment of asthma and prevention of virus-induced exacerbations.
1. Национальная программа «Бронхиальная астма у детей. Стратегия лечения и профилактика». IV издание. М., 2012. / Natsional'naia programma «Bronkhial'naia astma u detei. Strategiia lecheniia i profilaktika». IV izdanie. M., 2012. [in Russian]
2. Chuchalin A, Khaltaev N, Antonov N et al. Chronic respiratory diseases and risk factors in 12 regions of the Russian Federation. Int J COPD 2014; 9: 963–74.
3. GINA 2015. ginasthma.org
4. Reddel H, Ware S, Marks G et al. Differences between asthma exacerbations and poor asthma control. Lancet 1999; 353: 364–9.
5. Sigurs N, Gustafsson PM, Bjarnason R et al. Severe respiratory syncytial virus bronchiolitis in infancy and asthma and allergy at age 13. Am J Respir Crit Care Med 171 (2): 137–41, 2005.
6. Sigurs N, Aljassim F, Kjellman B et al. Asthma and allergy patterns over 18 years after severe RSV bronchiolitis in the first year of life. Thorax 2010; 65 (12): 1045–52.
7. Weiss ST, Tager IB, Munoz A et al. The relationship of respiratory infections in early childhood to the occurrence of increased levels of bronchial responsiveness and atopy. Am Rev Respir Dis 1985; 131 (4): 573–8.
8. Stein RT, Sherrill D, Morgan WJ et al. Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years. Lancet 1999; 354 (9178): 541–5.
9. Szabo SM, Levy AR, Gooch KL et al. Elevated risk of asthma after hospitalization for respiratory syncytial virus infection in infancy. Paediatr Respir Rev 2013; 13 (Suppl. 2): S9–S15.
10. Stein RT. Long-term airway morbidity following viral LRTI in early infancy: recurrent wheezing or asthma? Paediatr Respir Rev 2009; 10 (Suppl 1): 29–31.
11. Kusel MM, de Klerk NH, Kebadze T et al. Early-life respiratory viral infections, atopic sensitization, and risk of subsequent development of persistent asthma. J Allergy Clin Immunol 2007; 119 (5): 1105–10.
12. Takeyama A, Hashimoto K, Sato M et al. Clinical and epidemiologic factors related to subsequent wheezing after virus-induced lower respiratory tract infections in hospitalized pediatric patients younger than 3 years. Eur J Pediatr 2014; 173: 959–66.
13. O’Callaghan-Gordo C, Bassat Q, Diez-Padrisa N et al. Lower respiratory tract infections associated with rhinovirus during infancy and increased risk of wheezing during childhood. A cohort study. PLoS One 2013; 8 (7): e69370. doi: 10.1371/journal.pone.0069370
14. Jackson DJ, Gangnon RE, Evans MD et al. Wheezing rhinovirus illnesses in early life predict asthma development in high-risk children. Am J Respir Crit Care Med 2008; 178: 667–72.
15. Sly PD, Boner AL, Bjorksten B et al. Earlyidentification of atopy in the predictionof persistent asthma in children. Lancet 2008; 372: 1100–6.
16. Woodruff P, Bhakta N, Fahy J. Asthma: Pathogenesis and Phentoypes. In: Murray and Nadel’s textbook of respiratory medicine. 6-th Edition, printed of Elsevier Inc., 2016; p. 713–30.
17. Martinez FD, Wright AL, Taussig LM et al. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med 1995; 332 (3): 133–8.
18. Martinez FD, Stern DA, Wright AL et al. Differential immune responses to acute lower respiratory illness in early life and subsequent development of persistent wheezing and asthma. J Allergy Clin Immunol 1998; 102 (6 Pt 1): 915–20.
19. Soto-Quiros M, Avila L, Platts-Mills T et al. High titers of IgE antibody to dust mite allergen and risk for wheezing among asthmatic children infected with rhinovirus.
J Allergy Clin Immunol 2012; 129: 1499–505.
20. Macaubas C, de Klerk NH, Holt BJ et al. Association between antenatal cytokine production and the development of atopy and asthma at age 6 years. Lancet 2003; 362: 1192–7.
21. Johnston NW, Johnston SL, Duncan JM et al. The September epidemic of asthma exacerbations in children: a search for etiology. J Allergy Clin Immunol 2005; 115: 132–8.
22. Longini IM, Monto AS, Koopman JS. Statistical procedures for esti- mating the community probability of illness in family studies: rhinovirus and influenza. Int J Epidemiol 1984; 13: 99–106.
23. Freymuth F, Vabret A, Brouard J et al. Detection of viral, Chlamydia pneumoniae and Mycoplasma pneumoniae infections in exacerbations of asthma in children. J Clin Virol 1999; 13: 131–9.
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30. Busse WW, Morgan WJ, Gergen PJ et al. Randomized trial of omalizumab (anti-IgE) for asthma in inner-city children. N Engl J Med 2011; 364: 1005–15.
31. Bui RH, Molinaro GA, Kettering JD et al. Virus-specific IgE and IgG4 antibodies in serum of children infected with respiratory syncytial virus. J Pediatr 1987; 110: 87–90.
32. Rabatic S, Gagro A, Lokar-Kolbas R et al. Increase in CD23+ B cells in infants with bronchiolitis is accompanied by appearance of IgE and IgG4 antibodies specific for respiratory syncytial virus. J Infect Dis 1997; 175: 32–7.
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34. Stephens R, Randolph DA, Huang G et al. Antigen-nonspecific recruitment of Th2 cells to the lung as a mechanism for viral infection-induced allergic asthma. J Immunol 2002; 169: 5458–67.
35. Cheung DS, Ehlenbach SJ, Kitchens T et al. Development of atopy by severe paramyxoviral infection in a mouse model. Ann Allergy Asthma Immunol 2010; 105: 437–43.
36. Cheung DS, Grayson MH. Role of Viruses in the Development of Atopic Disease in Pediatric Patients. Curr Allergy Asthma Rep 2012. DOI 10.1007/s11882-012-0295-y
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________________________________________________
1. Natsional'naia programma «Bronkhial'naia astma u detei. Strategiia lecheniia i profilaktika». IV izdanie. M., 2012. [in Russian]
2. Chuchalin A, Khaltaev N, Antonov N et al. Chronic respiratory diseases and risk factors in 12 regions of the Russian Federation. Int J COPD 2014; 9: 963–74.
3. GINA 2015. ginasthma.org
4. Reddel H, Ware S, Marks G et al. Differences between asthma exacerbations and poor asthma control. Lancet 1999; 353: 364–9.
5. Sigurs N, Gustafsson PM, Bjarnason R et al. Severe respiratory syncytial virus bronchiolitis in infancy and asthma and allergy at age 13. Am J Respir Crit Care Med 171 (2): 137–41, 2005.
6. Sigurs N, Aljassim F, Kjellman B et al. Asthma and allergy patterns over 18 years after severe RSV bronchiolitis in the first year of life. Thorax 2010; 65 (12): 1045–52.
7. Weiss ST, Tager IB, Munoz A et al. The relationship of respiratory infections in early childhood to the occurrence of increased levels of bronchial responsiveness and atopy. Am Rev Respir Dis 1985; 131 (4): 573–8.
8. Stein RT, Sherrill D, Morgan WJ et al. Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years. Lancet 1999; 354 (9178): 541–5.
9. Szabo SM, Levy AR, Gooch KL et al. Elevated risk of asthma after hospitalization for respiratory syncytial virus infection in infancy. Paediatr Respir Rev 2013; 13 (Suppl. 2): S9–S15.
10. Stein RT. Long-term airway morbidity following viral LRTI in early infancy: recurrent wheezing or asthma? Paediatr Respir Rev 2009; 10 (Suppl 1): 29–31.
11. Kusel MM, de Klerk NH, Kebadze T et al. Early-life respiratory viral infections, atopic sensitization, and risk of subsequent development of persistent asthma. J Allergy Clin Immunol 2007; 119 (5): 1105–10.
12. Takeyama A, Hashimoto K, Sato M et al. Clinical and epidemiologic factors related to subsequent wheezing after virus-induced lower respiratory tract infections in hospitalized pediatric patients younger than 3 years. Eur J Pediatr 2014; 173: 959–66.
13. O’Callaghan-Gordo C, Bassat Q, Diez-Padrisa N et al. Lower respiratory tract infections associated with rhinovirus during infancy and increased risk of wheezing during childhood. A cohort study. PLoS One 2013; 8 (7): e69370. doi: 10.1371/journal.pone.0069370
14. Jackson DJ, Gangnon RE, Evans MD et al. Wheezing rhinovirus illnesses in early life predict asthma development in high-risk children. Am J Respir Crit Care Med 2008; 178: 667–72.
15. Sly PD, Boner AL, Bjorksten B et al. Earlyidentification of atopy in the predictionof persistent asthma in children. Lancet 2008; 372: 1100–6.
16. Woodruff P, Bhakta N, Fahy J. Asthma: Pathogenesis and Phentoypes. In: Murray and Nadel’s textbook of respiratory medicine. 6-th Edition, printed of Elsevier Inc., 2016; p. 713–30.
17. Martinez FD, Wright AL, Taussig LM et al. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med 1995; 332 (3): 133–8.
18. Martinez FD, Stern DA, Wright AL et al. Differential immune responses to acute lower respiratory illness in early life and subsequent development of persistent wheezing and asthma. J Allergy Clin Immunol 1998; 102 (6 Pt 1): 915–20.
19. Soto-Quiros M, Avila L, Platts-Mills T et al. High titers of IgE antibody to dust mite allergen and risk for wheezing among asthmatic children infected with rhinovirus.
J Allergy Clin Immunol 2012; 129: 1499–505.
20. Macaubas C, de Klerk NH, Holt BJ et al. Association between antenatal cytokine production and the development of atopy and asthma at age 6 years. Lancet 2003; 362: 1192–7.
21. Johnston NW, Johnston SL, Duncan JM et al. The September epidemic of asthma exacerbations in children: a search for etiology. J Allergy Clin Immunol 2005; 115: 132–8.
22. Longini IM, Monto AS, Koopman JS. Statistical procedures for esti- mating the community probability of illness in family studies: rhinovirus and influenza. Int J Epidemiol 1984; 13: 99–106.
23. Freymuth F, Vabret A, Brouard J et al. Detection of viral, Chlamydia pneumoniae and Mycoplasma pneumoniae infections in exacerbations of asthma in children. J Clin Virol 1999; 13: 131–9.
24. Nicholson KG, Kent J, Ireland DC. Respiratory viruses and exacerbations of asthma in adults. BMJ 1993; 307: 982–6.
25. Teichtahl H, Buckmaster N, Pertnikovs E. The incidence of respiratory tract infection in adults requiring hospitalization for asthma. Chest 1997; 112: 591–6.
26. Atmar RL, Guy E, Guntupalli KK et al. Respiratory tract viral infections in inner-city asthmatic adults. Arch Intern Med 1998; 158: 2453–9.
27. Dziublik A.Ia., Simonov S.S., Iachnik V.A. Klinicheskaia effektivnost' i bezopasnost' protivovirusnogo preparata Ingavirin v kompleksnom lechenii bol'nykh s obostreniem bronkhial'noi astmy, assotsiirovannym s ORVI. Pul'monologiia. 2013; 6: 43–50. [in Russian]
28. Message SD, Laza-Stanca V, Mallia P et al. Rhinovirus-induced lower respiratory illness is increased in asthma and related to virus load and Th1/2 cytokine and IL-10 production. Proc Natl Acad Sci U S A 2008; 105: 13562–7.
29. Green RM, Custovic A, Sanderson G et al. Synergism between allergens and viruses and risk of hospital admission with asthma: case-control study. BMJ 2002; 324: 763.
30. Busse WW, Morgan WJ, Gergen PJ et al. Randomized trial of omalizumab (anti-IgE) for asthma in inner-city children. N Engl J Med 2011; 364: 1005–15.
31. Bui RH, Molinaro GA, Kettering JD et al. Virus-specific IgE and IgG4 antibodies in serum of children infected with respiratory syncytial virus. J Pediatr 1987; 110: 87–90.
32. Rabatic S, Gagro A, Lokar-Kolbas R et al. Increase in CD23+ B cells in infants with bronchiolitis is accompanied by appearance of IgE and IgG4 antibodies specific for respiratory syncytial virus. J Infect Dis 1997; 175: 32–7.
33. Cheung DS, Ehlenbach SJ, Kitchens RT et al. Cutting edge: CD49d+ neutrophils induce FcepsilonRI expression on lung dendritic cells in a mouse model of postviral asthma. J Immunol. 2010; 185: 4983–7.
34. Stephens R, Randolph DA, Huang G et al. Antigen-nonspecific recruitment of Th2 cells to the lung as a mechanism for viral infection-induced allergic asthma. J Immunol 2002; 169: 5458–67.
35. Cheung DS, Ehlenbach SJ, Kitchens T et al. Development of atopy by severe paramyxoviral infection in a mouse model. Ann Allergy Asthma Immunol 2010; 105: 437–43.
36. Cheung DS, Grayson MH. Role of Viruses in the Development of Atopic Disease in Pediatric Patients. Curr Allergy Asthma Rep 2012. DOI 10.1007/s11882-012-0295-y
37. Al-Garawi AA, Fattouh R, Walker TD et al. Acute, but not resolved, influenza A infection enhances susceptibility to house dust mite-induced allergic disease. J Immunol 2009; 182: 3095–104.
38. Durrani SR, Montville DJ, Pratt AS et al. Innate immune responses to rhinovirus are reduced by the high-affinity IgE receptor in allergic asthmatic children. J Allergy Clin Immunol 2012; 130: 489–95.
39. Holtzman MJ. Asthma as a chronic disease of the innate and adaptive immune systems responding to viruses and allergens. J Clin Invest 2012; 122 (8): 2741–8.
40. Gavala ML, Bertics PJ, Gern JE. Rhinoviruses, allegic inflammation and asthma. Immunol Rev 2011; 242 (1): 69–90.
41. Wark PA, Johnston SL, Bucchieri F et al. Asthmatic bronchial epithelial cells have a deficient innate immune response to infection with rhinovirus. J Exp Med 2005; 201 (6): 937–47.
42. Contoli M, Message SD, Laza-Stanca V et al. Role of deficient type III interferon-lambda production in asthma exacerbations. Nat Med 2006; 12 (9): 1023–6.
43. Lopez-Souza N, Favoreto S, Wong H et al. In vitro susceptibility to rhinovirus infection is greater for bronchial than for nasal airway epithelial cells in human subjects. J Allergy Clin Immunol 2009; 123 (6): 1384–90 e2.
44. Schwantes E, Denlinger L, Evans M et al. Severity of virus-induced asthma symptoms is inversely related to resolution IFN-l expression. J Allergy Clin Immunol 2015; 135 (6): 1656–9.
45. Shadman KA, Wald ER. A review of palivizumab and emerging therapies for respiratory syncytial virus. Expert Opin Biol Ther 2011; 11 (11): 1455–67.
46. Simoes EA, Groothuis JR, Carbonell-Estrany X et al. Palivizumab prophylaxis, respiratory syncytial virus, and subsequent recurrent wheezing. J Pediatr 2007; 151: 34–42. 42 e31.
47. Suissa S, Ernst P, Benayoun S et al. Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med 2000; 343: 332–6.
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Авторы
Н.М.Ненашева
ГБОУ ВПО Российская медицинская академия последипломного образования Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1 rmapo@rmapo.ru
________________________________________________
N.M.Nenasheva
Russian Medical Academy for Postgraduate Education of the Ministry of Health of the Russian Federation. 125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1 rmapo@rmapo.ru