Viral lower respiratory tract infection in infants and young children
BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7405.36 (Published 03 July 2003) Cite this as: BMJ 2003;327:36
All rapid responses
There is now convincing evidence that children who develop lower
respiratory symptoms during infection with respiratory syncytial virus
(RSV) in early life are at increased risk of developing asthma-like
symptoms during the school years (1). However, both genetic and
environmental factor are thought to play a role in determining the type of
immune response elicited against the RSV virus.
RSV has been shown to elicit an exaggerated type 2 helper T cell
dominated immune response (TH2) in those who later develop asthma. This
exaggerated TH2 has also been a hindrance in the development of an
effective vaccine due to vaccine-enhanced disease (2). Moreover, RSV
viruses have shown to impair the development of CD8 memory T cells and
therefore may limit the duration of protective immunity from vaccines (3).
Therefore, development of an effective vaccine in the prevention of
RSV or immunotherapy to modulate the immune response to a more type 1
helper T cell response in severe RSV infection may help to curb the
current epidemic of childhood asthma.
References:
1. Martinez FD. Respiratory syncytial virus bronchiolitis and the
pathogenesis of childhood asthma. : Pediatr Infect Dis J. 2003 Feb;22(2
Suppl):S76-82
2. Graham BS, Johnson TR, Peebles RS. Immune-mediated disease
pathogenesis in respiratory syncytial virus infection. Immunopharmacology.
2000 Jul 25;48(3):237-47.
3. Chang J, Braciale TJ. Respiratory syncytial virus infection
suppresses lung CD8+ T-cell effector activity and peripheral CD8+ T-cell
memory in the respiratory tract. Nat Med. 2002 Jan;8(1):54-60
Competing interests:
None declared
Competing interests: No competing interests
Management of viral LRTI's in Infants: Remember the nose
As a pediatrician who treats dozens of hospitalized infants with
viral LRTI's annually, I have been most impressed with three
interventions: 1) A good nurse 2)oxygen and 3)keeping the nasal passages
clear with nasal decongestant drops. These infants are already working
excessively hard at breathing because of lower airway obstruction, and
many have clogged nasal passages which futhur increases their labored
breathing and their difficulty with feeding. I agree with the authors that
inhaled broncodilators and steroids for young infants are almost always
ineffective, and are given more for our benefit than the infant's.
Competing interests:
None declared
Competing interests: No competing interests