Introduction
Adenoviruses are a group of viruses that can cause various types of infections. These viruses were discovered in the early 1950s, when there was huge economic burden from viral respiratory diseases in the general population. Different serotypes of Adenovirus have been identified, which can replicate and produce diseases at various sites like:
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Gastrointestinal tract.
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Respiratory tract.
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Central nervous system (CNS).
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Urinary bladder.
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Eye.
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Skin, etc.
The portions of the genome have been identified in the circulating lymphocytes, tonsils, respiratory epithelium, etc.
Asthma is a chronic inflammatory disease of the lungs that is characterized by recurrent episodes of narrowing or obstruction that result from swelling of the airways, increased mucus production, and bronchospasm. It can begin at any age and can also affect children and is known as childhood asthma or pediatric asthma. The symptoms can be severe in some children and can interfere with play, studies, sleep, or other daily activities.
What Are the Symptoms of Viral Infection-Induced Asthma?
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Recurrent wheezing (whistling sound on breathing).
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Upper respiratory tract infection symptoms such as running nose, and congestion.
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Constant cough which affects the child’s play, speech, etc, and is especially increased during the night affecting sleep.
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Difficulty breathing.
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Fever.
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Increased heart rate.
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Fatigue.
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Eye irritation.
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Rash.
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Chest pain or chest tightness.
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Anxiety and irritability.
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Some strains of Adenovirus can also cause gastrointestinal infections leading to abdominal cramps and diarrhea.
How Do Adenovirus Infections Occur?
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Adenoviruses can spread from person to person through respiratory droplets and contact with contaminated surfaces and are commonly seen in children under five years of age.
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Children usually get infected at schools, daycare facilities, or other public places such as parks, summer camps, swimming pools, etc.
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The incubation period is two days to two weeks before the symptoms are noticed.
What Is the Role of Adenovirus in Pediatric Patients With Asthma?
The human Adenovirus is composed of a highly ordered structure of about 87 percent protein and 13 percent DNA, a well-organized capsid protein made of hexon macromolecules. This structure of the adenoviral protein makes it possible for it to bind to the host, achieve protein synthesis, and allow it to replicate and grow further. The continued expression of the viral proteins can lead to chronic inflammation and cell hyperplasia (increased cell production) of the respiratory epithelium, resulting in changes in the airways. Although Adenovirus infections are known to be self-limiting, in some rare cases, they can cause serious morbidity and complications.
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Viral infections of the respiratory tract are one of the most common causes of wheezing or asthma in children and adults. The crucial period of asthma initiation appears to be the first two or three years of life, during which maximum growth and remodeling of the lungs and the airways occur. Approximately 90 to 95 percent of children have asthma flare-ups due to viral infections.
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Although significant progress has been made in understanding the causes or triggering factors of asthma, the exact mechanism is still unclear. However, researchers believe that the continuous stimulation of the immune system by the virus or the adenoviral proteins of the virus increases the inflammatory response, allowing it to persist and resulting in an inflammatory disease of the airways.
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Wheezing associated with viral infections is most commonly triggered by human Rhinoviruses (RV) and Respiratory Syncytial Viruses (RSV). Other organisms include Adenovirus, influenza, parainfluenza, Coronavirus, Enterovirus, etc., which can trigger acute exacerbations and may predispose infants or young children to develop asthma later.
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It usually begins with acute bronchiolitis, characterized by inflammation, mucus production, spasms, and narrowing of the bronchi, which results in difficulty breathing.
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Recurrent episodes of wheezing because of viral infections can progress to asthma or exacerbate the underlying disease.
What Are the Risk Factors for Adenovirus Infection in Children With Asthma?
The risk factors associated with an Adenovirus infection in pediatric asthma patients include:
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A family history of asthma or allergies.
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Low immunity.
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Prenatal or postnatal exposure to tobacco.
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Living in an area with high levels of air pollution.
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Frequent hospitalization.
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Poor hygiene.
How Is Adenovirus Infection in Kids With Childhood Asthma Diagnosed?
A doctor must be immediately consulted if the child is has severe fever, cough, dehydration, and difficulty breathing. The doctor may review the symptoms and take a swab sample by taking a sample of the fluid from the nose and sending it to a laboratory for virus culture tests to confirm the diagnosis. Blood tests, urine tests, or stool tests may also be advised in some cases. A chest X-ray may be recommended in some severe cases to detect the changes in the lungs and to rule out other conditions.
What Measures Can Prevent Adenovirus Infections?
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Following proper hygiene by washing hands frequently with soap or hand wash.
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Avoiding touch or close contact with people or sharing things, especially in school.
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Frequent use of alcohol-based sanitizers can also be effective.
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Covering the nose and mouth with a mask, or a handkerchief.
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Cleaning and disinfection of toys, floor, and other surfaces.
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Avoiding allergens such as pollen, dust, tobacco smoke, pets, etc.
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Eating a healthy and balanced diet, adequate sleep, probiotic supplements, and regular exercises.
How Is Adenovirus Infection Managed in Kids With Asthma?
The symptoms of virus-induced asthma are usually managed the same way as regular asthmatic episodes. No specific medications are available to treat Adenovirus infections, but some kids with mild infections may recover with home remedies and without medications. Some of the treatment methods include:
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Quick relief inhalers such as short-acting beta-agonists (SABA) like Albuterol, Levalbuterol, or anticholinergics such as Ipratropium bromide, etc.
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Long-term asthma control medications include; oral corticosteroids such as Prednisone, inhaled corticosteroids such as Fluticasone, Budesonide, etc
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Long-acting beta-agonists (LABA) such as Formoterol, Salmeterol, etc
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Combination of inhaled corticosteroids and LABA inhalers.
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Adequate intake of fluids to prevent dehydration and non-steroidal anti-inflammatory drugs (NSAIDs) such as Acetaminophen, Ibuprofen, etc are prescribed to manage fever.
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Installation of humidifiers which may help reduce mucus congestion and facilitate easy breathing.
Conclusion
There is an intricate link between asthma and respiratory virus infections. Viruses such as Adenovirus, influenza, corona, etc. can increase the risk of wheezing or asthmatic episodes in children. The pathogenic mechanisms for the same are still incompletely understood. Recurrent viral infections in kids with childhood asthma are challenging to manage; however, optimal strategies such as quick relief inhalers or long-term medications along with symptomatic treatment and following certain preventive measures can be beneficial in the majority of cases.
