[Exacerbation in asthma: definitions and immunopathology].

There is no unequivocal definition of exacerbation in asthma. These are defined as episodes of increased or aggravated respiratory symptoms or as use of oral corticosteroid therapy. Viral infection is the most frequent cause of exacerbations. Inflammation during exacerbations is heterogeneous. It may be associated with bronchial hypereosinophilia, which is used as a predictive marker for exacerbation, and with neutrophilia, which is more resistant to corticosteroids. During viral infection, an inappropriate Th1 antiviral inflammation develops, associated with the intrinsic Th2 activity that leads to an aberrant immune response. Exacerbations secondary to allergen exposure are classically described as due to a Th2-type inflammation; but Th1 response also seems to play a role. Exposure to air pollutants appears able not only to induce bronchial inflammation but also to potentiate the inflammatory reactions of patients with exacerbations.