Attenuating COVID-19 infection and inflammation: Lessons from asthma.
Attenuating COVID-19 infection and inflammation: Lessons from asthma.
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减轻 COVID-19 感染和炎症：哮喘的教训。
DOI：
10.1111/resp.13961
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Bardin PG
中科院分区：
文献类型：
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作者：
Bardin PG
在当前全球大流行的动荡中，人们往往忘记2019冠状病毒病（COVID-19）是一种普通的感冒病毒，尽管它带有冠状病毒。COVID-19感染有几个独特的特征，但两个关键方面主导了这种疾病。首先，作为一种普通的感冒病毒，它具有这种病毒群的典型能力，尽管几乎采取了任何旨在根除传播的干预措施，但它仍然非常容易在人与人之间传播。第二，初始上呼吸道受累在易受肺部感染的人中进展，病毒载量不受控制，导致炎症增加，导致呼吸障碍和衰竭。1，2不容易理解的是哮喘急性发作发生在几乎相同的环境中：易感人群中的普通感冒病毒感染随后是病毒载量增加、肺部感染和炎症，随后是呼吸系统损害。鉴于这些相似之处，从长期有效治疗病毒引起的哮喘急性发作的历史中，是否可以学到适用于COVID-19的宝贵经验？超过200种不同的病毒可以引起普通感冒，但鼻病毒，冠状病毒，呼吸道合胞病毒和副流感病毒与大多数感冒有关。直到最近，尽管20世纪90年代初的里程碑式研究表明哮喘急性发作主要由普通感冒引发，但它们作为传染源的重要性仍被低估。3对哮喘患者的研究表明，扩散到肺部后会出现炎症、气道阻塞、反应性增强和呼吸功能受损。然而，在早期阶段，很明显，预防感染是具有挑战性的，针对普通感冒病毒的具体治疗方法仍然难以捉摸。为了对抗这些病毒对肺部的急性有害影响，必须设计其他策略。哮喘急性发作可导致死亡，通常发生在年轻人中，口服或胃肠外皮质类固醇（CS）抗炎治疗可有效缓解急性发作。5减弱病毒感染的有害炎症影响使得降低死亡率成为可能，因此CS仍被广泛用于治疗病毒相关的哮喘急性发作。一个关键的信息是，控制炎症足以恢复合理的肺功能，而宿主的免疫反应最终消除了病毒。
In the turmoil surrounding the current global pandemic, it is often forgotten that coronavirus disease 2019 (COVID-19) is a common cold virus, albeit with a crown. Infection by COVID-19 has several unique features, but two key aspects dominate the disease. First, as a common cold virus, it has the classic ability of this virus group to spread very readily person-to-person despite virtually any intervention aimed at eradicating transmission. Second, initial upper airway involvement progresses in susceptible persons to lung infection with uncontrolled virus loads leading to mounting inflammation resulting in respiratory impairment and failure. 1, 2 What is not readily appreciated is that asthma exacerbations occur in an almost identical setting: a common cold virus infection in susceptible persons is followed by increased virus loads, lung infection and inflammation with subsequent respiratory compromise. Given these similarities, are there valuable lessons applicable to COVID-19 to be learned from a long history of effective treatment for virus-induced asthma exacerbations?More than 200 different viruses can cause a common cold but rhinoviruses, coronaviruses, respiratory syncytial and parainfluenza viruses are implicated in the majority of colds. Until recently, their importance as infectious agents was underestimated despite landmark studies in the early 1990s demonstrating that asthma exacerbations are predominantly triggered by common colds. 3 Studies in individuals with asthma demonstrated that spread to the lung was followed by inflammation, airway obstruction, heightened responsiveness and respiratory compromise. 4 However, at an early stage, it was clear that preventing infection was challenging and specific treatments for common cold viruses have remained elusive. Other strategies had to be devised in order to counter acute detrimental effects of these viruses on the lung. Asthma exacerbations can lead to death, often in young persons, and anti-inflammatory treatment with oral or parenteral corticosteroids (CS) effectively mitigate exacerbations. 5 Blunting the detrimental inflammatory impacts of virus infection made it possible to reduce mortality and consequently CS have remained in widespread use to treat virus-associated asthma exacerbations. A key message has been that controlling inflammation was sufficient to restore reasonable lung function whilst host immune responses ultimately eliminated the virus.