Understand Links Between RSV, Pediatric Asthma, and COVID-19

Author(s):

Ellie Provisor, PharmD

RSV can exacerbate asthma development by causing damage to the tissue in the airways, promoting inflammation and increasing airway hyper-responsiveness

Respiratory syncytial virus (RSV) can cause lower respiratory tract infections such as acute bronchiolitis and spreads through respiratory droplets and close contact. Annually, RSV results in approximately 33 million acute cases of lower respiratory tract infections, 3.2 million hospitalizations, and more than 100,000 deaths in pediatric patients younger than 5 years.

mother holding asthma inhaler for child coughing

Image credit: Prostock-studio | stock.adobe.com

Studies have linked severe RSV bronchiolitis in childhood to the development of wheezing, asthma, and airway remodeling, but the connection was never well understood. The European Journal of Clinical Microbiology & Infectious Diseases published a review article looking at RSV and its implications in the development of pediatric asthma. The review also highlights how the virus causes similar disruptions in the immune system to SARS-CoV-2, the virus that causes COVID-19.

This study provided evidence that RSV can exacerbate asthma development by causing damage to the tissue in the airways, promoting inflammation and increasing airway hyper-responsiveness. These effects eventually cause airway remodeling.

Although this review provides extensive discussion on RSV’s possible involvement in the development of pediatric asthma, the data are insufficient to confirm it as an independent cause.

During the COVID-19 pandemic, the prevalence of RSV decreased because of restrictive public measures such as social distancing and masking. RSV and SARS-COV-2 both have single-strand RNA and cause similar disruptions in immune response, leading to increased reinfection and risk of severe tissue injury.

Both viruses cause dysregulation of TLR signaling, which helps with the initial recognition of invading pathogens, and both increase the activity of NLRP3 inflammasomes, which leads to increased inflammation in the body. The viruses also suppress HLA-DR activity, which increases disease severity in infants for RSV and adults for COVID-19.

RSV infection is a severe health concern, and prevention is imperative because it may decrease the incidence of pediatric asthma. This review provides insight into future preventative and treatment methods for RSV by using lessons learned from the pandemic’s public health measures and insights on specific immunologic changes from RSV and COVID-19 virus.