Post-COVID-19 as a risk factor for development and progression of bronchial asthma

Bronchial asthma (BA) is one of the most common chronic respiratory diseases worldwide. In Russia, the prevalence of asthma among the adult population is 6.9%.Its pathogenesis is associated with a complex interaction of genetic, environmental, and immune factors, among which acute respiratory viral infections play a significant role. These pathogens can damage the airway epithelium, triggering chronic inflammation and inducing a Th2immune response with hyperproduction of interleukin (IL) 4, IL-5, and IL-13. The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has highlighted the long-term consequences of the infection, including the risk of developing new cases of asthma and worsening existing asthma. Virus-induced airway inflammation mediated by type 2 immune mechanisms (T2 inflammation) may play a key role in the pathogenesis of asthma in the post-COVID-19 period. In support of this hypothesis, recent retrospective studies have shown that in adult patients, the risk of asthma exacerbations requiring enhanced maintenance therapy may persist for an average of 6–14 months after COVID-19. These findings suggest that a significant proportion of asthma patients may experience loss of asthma control after COVID-19, which may lead to an increased long-term risk of severe exacerbations (requiring hospitalization) and mortality. Currently, data on the long-term effects of SARS-CoV-2 on immune pathways regulating T2 inflammation, the role of IL-13 in the persistence of post-COVID-19 respiratory symptoms, the effectiveness of biological therapies (e.g., anti-IL-13/IL-4) for preventing asthma after COVID-19, and the impact of COVID-19 on the long-term risk of severe exacerbations and mortality are insufficient. This review integrates the results of molecular, immunological, and clinical studies, offering a comprehensive perspective.

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