Rhinovirus-Induced Exacerbations of Asthma and COPD

Hershenson, Marc B.

Readers of this paper who care for patients with asthma will be familiar with the following scenario. A patient with recurrent cough and wheeze presents to the clinic for evaluation. The patient states that the only time she has respiratory symptoms is fall, winter, and spring following "colds. " She has no symptoms in the summer, or between colds. She denies she has asthma and does not feel the need to take inhaled steroids even though she has been prescribed them in the past. My response to this patient, and the premise of this review, is that many patients have asthma which is only triggered by viral upper respiratory tract infections. Nevertheless, the role of viral infections in the exacerbation of asthma, chronic obstructive disease (COPD), and other chronic airways diseases was almost completely ignored until the late 1990s, when more sensitive methods of viral detection were developed. While the emphasis of allergic sensitization in the pathogenesis in asthma is strongly justified, serious exacerbations of this disease are more likely to relate to viral infection rather than allergen exposure (Table 1) .