Can Adults Develop Viral-Induced Wheeze?
Yes, adults can absolutely develop viral-induced wheeze, and this occurs both in those with pre-existing respiratory conditions like asthma or COPD, and even in adults without any underlying lung disease.
Viral-Induced Wheeze in Adults Without Pre-existing Conditions
Adults without asthma or COPD can experience episodic wheezing triggered exclusively by viral respiratory infections, a phenomenon distinct from classical atopic asthma:
Experimental infection studies demonstrate that adults with a history of exclusive viral wheeze develop lower respiratory tract symptoms including wheeze, chest tightness, and shortness of breath when infected with respiratory viruses, even when they have normal baseline lung function and airway responsiveness 1
This viral wheeze model is characterized by neutrophilic inflammation (not eosinophilic) in both upper and lower airways, with IL-8 serving as the key inflammatory mediator 2
Importantly, this occurs independently of atopic status—both atopic and non-atopic adults can develop viral wheeze, making it distinct from classical allergic asthma 1, 2
During viral infections, these adults experience progressive increases in airway hyperresponsiveness that can persist for weeks after the initial infection 1
Viral-Induced Wheeze in Adults With Asthma
For adults with existing asthma, viral respiratory infections are a dominant trigger for exacerbations and wheezing episodes:
Respiratory viruses, predominantly rhinoviruses, are associated with 80-89% of asthma exacerbations in adults, with colds reported in 80% of episodes involving wheeze, chest tightness, or breathlessness 3
Multiple respiratory viruses cause objective asthma exacerbations with measurable reductions in peak flow, including rhinoviruses, coronaviruses, influenza B, respiratory syncytial virus, parainfluenza virus, and even atypical pathogens like chlamydia 3
Adults with asthma may have deficiencies in antiviral activity and compromised airway epithelial barrier integrity, making them more susceptible to severe viral infections of the lower airways 4
Viral-Induced Wheeze in Adults With COPD
Adults with COPD are particularly vulnerable to viral-induced respiratory symptoms including wheeze:
RSV infection causes exacerbations in 80.4% of hospitalized adults with COPD, chronic bronchitis, or emphysema, with COPD exacerbation being a direct cause of death in 6.9% of RSV-related fatalities 5
Adults with COPD have RSV hospitalization rates 3.2 to 13.4 times higher than those without COPD, and up to 10 times higher in some surveillance studies 5
Viral respiratory tract infections can trigger COPD exacerbations, though there remains controversy about whether the microbiological infection itself is the clinically relevant phenomenon or simply a trigger for underlying airway inflammation 5
Clinical Recognition and Diagnostic Approach
When evaluating adults presenting with wheeze in the context of respiratory symptoms, consider the following algorithmic approach:
First, assess for wheezing with at least two of the following: prolonged expiration, smoking history, or symptoms of allergy—this warrants lung function testing to identify underlying chronic lung disease 5
The European Respiratory Society guidelines note that wheezing can indicate lower respiratory tract involvement and should prompt evaluation for acute bronchitis, asthma exacerbation, or COPD exacerbation 5
Differentiating between viral acute bronchitis and asthma/COPD exacerbations is critical because the latter benefit from bronchodilators (β-agonists) and steroids, while uncomplicated viral bronchitis does not 5
Critical Clinical Pitfalls
Do not assume that viral wheeze only occurs in children—this is a well-documented phenomenon in adults that can occur with or without underlying lung disease 1, 3
Avoid missing underlying chronic lung disease in patients presenting with viral respiratory infections and wheeze; up to 45% of patients with acute cough lasting more than 2 weeks may have undiagnosed asthma or COPD 5
Do not confuse viral-induced wheeze in previously healthy adults with new-onset asthma—the inflammatory profile is different (neutrophilic vs. eosinophilic) and the wheeze is episodic and exclusively viral-triggered 2
Be aware that viral infections can both trigger wheeze acutely and increase airway hyperresponsiveness that persists for weeks after symptom resolution 1