Infection in Severe Asthma Exacerbations and Critical Asthma Syndrome

Christian E Sandrock, Andrew Norris

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


In chronic persistent asthma and severe acute exacerbations of bronchial asthma, infectious agents are the predominant triggers that drive disease and airway pathobiology. In acute exacerbations of bronchial asthma (AEBA) including near fatal and fatal asthma, viral agents, particularly human rhinovirus-C, respiratory syncytial virus and influenza A appear to be the more prevalent and recurring threats. Both viral, and to a lesser extent bacterial agents, can play a role, and co-infection may also be present and worsen prognosis in hospitalized patients, placing a portion at risk for critical asthma syndrome. During severe acute exacerbations, infectious agents must be treated empirically, but the initial treatment regimens can vary and viral coverage may also vary based on seasonality and patient age. Early treatment with ceftriaxone and azithromycin, along with oseltamivir in winter months, should be initiated with all cases of severe exacerbations where infection is suspected, and definitely in critical asthma syndrome until infection is excluded by appropriate diagnostic testing. In this manuscript we will outline the impact of the major viral agents on severe asthma including the data from the 2009 H1N1 influenza pandemic. The role of bacterial infections in acute exacerbations of asthma will also be reviewed as well as the benefit of empiric antibiotics and the role of macrolides in both acute and chronic asthma.

Original languageEnglish (US)
Pages (from-to)104-113
Number of pages10
JournalClinical Reviews in Allergy and Immunology
Issue number1
StatePublished - 2014


  • Acute Exacerbation of Bronchial Asthma (AEBA)
  • Community acquired pneumonia
  • Critical asthma syndrome
  • Viral pneumonitis

ASJC Scopus subject areas

  • Immunology and Allergy


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