From the Guidelines
The most common cause of asthma exacerbation in teenagers is a recent viral infection. Viral respiratory infections, particularly rhinovirus infections, are the leading trigger for asthma exacerbations across all age groups, including adolescents, as highlighted in the Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma–Summary Report 2007 1. These infections cause inflammation of the airways, increased mucus production, and bronchial hyperresponsiveness, which worsen asthma symptoms.
Key Points to Consider
- The updated guidelines emphasize the importance of asthma control and the need to monitor the level of control on a periodic basis to determine whether therapy should be maintained or adjusted 1.
- Asthma severity is the intrinsic intensity of the disease process, and control is the degree to which the manifestations of asthma are minimized by therapeutic intervention 1.
- The guidelines provide new recommendations on patient education, environmental control measures, and the use of a written asthma action plan to manage asthma and recognize worsening symptoms 1.
Comparison with Other Triggers
While cold weather can certainly trigger asthma symptoms by causing airway cooling and drying, it is not the most common precipitating factor for exacerbations. Other common triggers include:
- Allergen exposure
- Exercise
- Air pollutants
- Strong emotional responses However, viral infections remain the predominant cause that clinicians should consider when evaluating a teenager with an asthma exacerbation.
Clinical Implications
Given the importance of viral infections in triggering asthma exacerbations, clinicians should prioritize this factor when assessing and managing teenagers with asthma, as recommended by the EPR-3 guidelines 1. This includes educating patients on recognizing the signs of a viral infection and the importance of adhering to their asthma action plan to prevent exacerbations.
From the Research
Causes of Asthma Exacerbation
- Viral infections are the most common cause of asthma exacerbation in both children and adults, with rhinovirus (RV) being the most frequently identified virus 2
- Respiratory viruses, such as influenza A, rhinovirus, and respiratory syncytial virus (RSV), play a major role in triggering asthma exacerbation 3, 4
- Other factors, including allergens, irritants, and occupational exposures, can also contribute to asthma exacerbations 5
Viral Infections and Asthma Exacerbation
- Viral infections can cause a greater degree of morbidity in asthmatic subjects than in the healthy population, due to an impaired antiviral response 2, 6
- The bronchial epithelium and inflammatory cells, mediators, and molecular pathways are involved in the immune response to viral infections, which can lead to asthma exacerbation 6
- Coinfection with two or more viruses can occur, and the type of viral infection can influence the severity of asthma exacerbation 3