Pathophysiology of airway viral infections

Viral infections are major causes of cough. Virus-induced changes in airway sensory nerve function include increased tachykinin expression and, more specifically, expression of tachykinins by Aδ fibers. This change may be mediated by neurotrophins produced in response to viral infection. At the same time, activity of neutral endopeptidase, an enzyme that is important in degrading and inactivating tachykinins, is decreased by airway viral infections. Viral infections can activate eosinophils, releasing proteins that can cause tachykinin release. Moreover, expression of the NK1 receptor is increased by viral infections of the lungs. The expression of M₂ muscarinic receptors, which normally decrease the sensitivity of sensory nerves, is decreased by viral infections. So it is possible that viral infections (1) increase expression of tachykinins (by causing neurotrophin expression), (2) increase release of tachykinins (by causing release of eosinophil proteins), (3) decrease degradation of tachykinins (by decreasing neutral endopeptidase activity), (4) increase expression of the NK1 receptor (again mediated by neurotrophins), and (5) increase the sensitivity of airway afferents (by decreasing M₂ muscarinic receptor expression). All these changes may potentiate the tachykininergic input into the cough reflex, and may provide new therapeutic targets for controlling virus-induced cough.