Asthma Diagnosis What Is Viral-Induced Asthma? By Kathleen MacNaughton, R.N. linkedin Kathleen MacNaughton, RN is a freelance writer with extensive experience in professional nursing and health care management. Learn about our editorial process Kathleen MacNaughton, R.N. Medically reviewed by Medically reviewed by Daniel More, MD on November 07, 2019 Daniel More, MD, is a board-certified allergist and clinical immunologist with a background in internal medicine. Learn about our Medical Review Board Daniel More, MD Updated on April 27, 2020 Print Table of Contents View All Symptoms Causes Diagnosis Treatment Prevention Viral-induced asthma is the onset of an asthma attack due to a respiratory tract infection. This includes viruses associated with the common cold and flu. It is estimated that no less than 50% of all acute asthma attacks are triggered by a respiratory virus. As opposed to poorly controlled asthma—in which attacks occur due to inadequate drug treatment or adherence)—viral-induced asthma can occur even in people with excellent asthma control. At present, there are no drugs known to reduce the frequency or severity of viral-induced asthma. The prevention of respiratory tract infections remains the best way to reduce your personal risk. Hero Images/Getty Images Viral-Induced Asthma Symptoms Viral-induced asthma can prompt a new onset of symptoms in adulthood (adult-onset asthma). In many cases, a person will have had asthma in early childhood that disappeared only to reappear later in life. It can also cause asthma exacerbations—attacks that occur in children and adults already diagnosed with asthma, including those with well-controlled disease. Regardless, the symptoms of viral-induced asthma are not dissimilar to other types of asthma, but they can often be more severe due to the co-occurring infection. This is especially true in people who smoke or have poorly controlled asthma. Common symptoms of viral-induced asthma include: WheezingCoughingChest tightnessShortness of breathFeverChillsFatigueNasal congestionHeadacheSinus painRunny noseSneezingLoss of appetite Adult-onset cases are especially troublesome as they are likely to be more persistent and harder to control, with a more rapid decline in lung function. This can increase a person's vulnerability to infection, including severe recurrent respiratory infections. People who routinely use a corticosteroid inhaler to control asthma are also more likely to develop pneumonia following a bout of viral-induced asthma due to the immunosuppressive properties of the drug. Likewise, severe or prolonged lower respiratory infections occurring within the lungs can make it more difficult to manage asthma, leading to a potentially severe asthma attack and a concerning cycle of illness. When to Call 911 Seek emergency care if signs of a severe asthma attack develop, including:Rapid breathingFlaring of nostrilsChest retractions (where the skin sucks in between the ribs when inhaling)An expanded chest that does not fully deflate during exhalationTrouble walking or talking due to shortness of breathBluish skin, lips, or fingernails (cyanosis)Failure to respond to or recognize parents/guardians (in infants) Common and Uncommon Symptoms of Asthma Causes Viral-induced asthma is linked to certain respiratory viruses. Among those associated with acute exacerbations or the new onset of disease are: RhinovirusesInfluenza viruses, especially influenza ARespiratory syncytial virus (RSV)Parainfluenza virusesAdenovirusesCoronavirusesPneumonia virusesHuman bocavirusEnterovirus 68 Of these, rhinoviruses account for 60% to 70% of all viral-induced asthma cases, with the majority of remaining cases linked to influenza viruses and RSV. However, it is unclear how these different viral infections trigger asthma. Most scientists agree that there is not a simple cause-and-effect relationship. What follows are a few hypotheses as to why viral-induced asthma occurs. Early Respiratory Infections Infants with RSV infections during the first six months of life—when the immune system is still developing—are more likely to experience asthma later in life. This suggests that early alterations of the immune response may cause an immune overreaction later in life when exposed to similar respiratory viruses. On the flip side, a maternal history of asthma appears to increase the risk of severe lower respiratory tract infections in infants and babies. Lower Respiratory Tract Involvement Asthma is characterized by hyper-responsiveness of the airways of the lower respiratory tract. With adult-onset asthma, a lower respiratory tract infection appears the most common risk factor for a first attack. This is likely because lower respiratory infections cause greater immune activation and airway inflammation. Still, it is unclear how an upper respiratory infection caused by a rhinovirus, for example, can induce hyper-responsiveness in the lower respiratory tract. Allergy-Induced Inflammation The risk of viral-induced asthma appears closely linked to chronic allergies, including allergic rhinosinusitis. Some scientists believe that the degree of chronic allergic inflammation in the airways is predictive of a person's risk of viral-induced allergies. The current view is that viral-induced asthma is caused by multiple factors, including a genetic predisposition to asthma, exposure to respiratory viruses early in life, delayed maturation of the immune system, and concurrent allergies. Causes and Risk Factors of Asthma Diagnosis Viral-induced asthma is often recognized by the development of classic asthma symptoms (bronchoconstriction accompanied by bronchospasms) in tandem with classic respiratory infection symptoms. Another tell-tale sign is the sudden appearance of symptoms in people who have otherwise had excellent asthma control. (If this is your first attack or you have not been previously diagnosed, your doctor will focus on treating the acute symptoms and refer you to a pulmonologist for a larger battery of tests to confirm that asthma is involved.) People with viral-induced asthma will typically demonstrate a significant reduction of lung function when tested with spirometry and other pulmonary function tests (PFTs). There should also be a notable drop in the peak expiratory flow rate (PEFR) since respiratory infections can cause PEFR declines in both asthmatic and non-asthmatic people. A chest X-ray may also be ordered if pneumonia is suspected, though this imaging is otherwise of limited value in diagnosing or characterizing asthma. A pulse oximeter will be used to measure blood oxygen levels as well. Treatment There are no specific treatments for viral-induced asthma other than what is commonly used to treat asthma exacerbations. Among the treatments commonly prescribed to treat acute asthma attacks: Inhaled bronchodilators, including beta-2 agonists and anticholinergics, are the mainstay of asthma treatment in the emergency departments. Short-acting beta-agonist (SABAs), also known as rescue inhalers, provide rapid dilation of the airways. Anticholinergics like ipratropium and tiotropium have similar actions.Corticosteroids, also known as steroids, can be delivered by an inhaler, taken by mouth, or infused intravenously (into a vein). What's best depends on the severity of your symptoms.Antivirals can shorten the course and severity of influenza and RSV. Drugs like Tamiflu (oseltamivir) may improve outcomes in people with influenza if taken with 48 hours of the appearance of symptoms. Virazole (ribavirin) is an inhaled powder used to treat severe RSV infections.Epinephrine, also known as adrenaline, is delivered by injection during a medical emergency to quickly dilate blood vessels and open airways, thereby reducing blood pressure and improving breathing.Antibiotics may be prescribed to treat secondary infections, like bacterial pneumonia, that can occur in severe or prolonged infections.Oxygen therapy may be needed if there is hypoxia (low blood oxygen) or severe pneumonia. Once your asthma is under control, your doctor will discuss treatment options to ensure better long-term management of your symptoms. How Asthma Is Treated Asthma Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Download PDF Email the Guide Send to yourself or a loved one. Sign Up This Doctor Discussion Guide has been sent to {{form.email}}. There was an error. Please try again. Prevention At present, there are no effective medications to prevent viral-induced asthma. Even if you take your asthma medications without fail and haven't had an attack in years, a viral-induced exacerbation can still occur. Until effective drug interventions are found, the best form of treatment is prevention. Among the recommendations: Get a flu shot every year.Wash your hands frequently with soap and water.Avoid people with colds, flu, or other respiratory infections.Avoid touching your eyes, nose, or mouth. Children in high-risk groups, including preterm babies and infants with chronic lung disease, are now given a preventive monoclonal antibody called Synagis (palivizumab) that may provide modest protection against RSV. Scientists are exploring other medications that may one day protect against viral-induced exacerbations. These include inhaled interferon-beta which appears to enhance the body's response to certain respiratory infections. Research to date has been conflicted, although people with severe asthma appear to benefit. How to Prevent Asthma Attacks A Word From Verywell People with persistent asthma are not only susceptible to respiratory infections, but they tend to experience more severe symptoms if one occurs. With that said, getting a respiratory infection does not mean you will have an asthma attack. Often, more than one trigger will be involved, such as a respiratory infection in someone who smokes. In the end, the best thing you can do to avoid viral-induced asthma is to optimize your health. Eating nutritiously, exercising, seeing your primary care physician regularly, staying up-to-date on your vaccines, and quitting cigarettes can go along way to avoiding illness or reducing the severity of a cold or flu infection, if one develops. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Oliver BG, Robinson P, Peters M, Black J. Viral infections and asthma: an inflammatory interface?. Eur Respir J. 2014;44(6):1666-81. doi:10.1183/09031936.00047714 Hansbro NG, Horvat JC, Wark PA, Hansbro PM. Understanding the mechanisms of viral induced asthma: new therapeutic directions. Pharmacol Ther. 2008;117(3):313-53. doi:10.1016/j.pharmthera.2007.11.002 Juhn YJ. 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Healthy habits to help prevent flu. Updated November 7, 2019. Olchanski N, Hansen RN, Pope E, et al. Palivizumab prophylaxis for respiratory syncytial virus: Examining the evidence around value. Open Forum Infect Dis. 2018;5(3):ofy031. doi:10.2147/JAA.S125948 Djukanović R, Harrison T, Johnston SL, et al. The effect of inhaled interferon-β on worsening of asthma symptoms caused by viral infections: a randomised trial. Am J Respir Crit Care Med 2014;190145-54. doi:10.1164/rccm.201312-2235OC