Cytokine Imbalance in a 15-year-old Boy with Pandemic Influenza an Infection Requiring Extracorporeal Membrane Oxygenation

Acute severe asthma is an acute episode of intractable asthma that is poorly responsive to standard management. Acute respiratory failure or acute respiratory distress syndrome (ARDS) requiring ventilator support may be life-threatening. Although respiratory viral infections are responsible for most asthma exacerbations, the seasonal influenza virus has not been considered a risk factor. However, the 2009 H1N1 influenza A pandemic strain (pH1N1), which has resulted in numerous hospitalizations and mortalities worldwide, has been reported to be closely related to asthma exacerbation. Thus, with over 300 million people suffering from asthma worldwide, further studies are needed to protect this vulnerable population that is highly susceptible to pH1N1 infection. Dysregulation of Th1/Th2 cytokines may be involved in asthma exacerbation. We report the case of a paediatric patient with acute respiratory failure due to asthma exacerbation triggered by pH1N1 infection. The patient exhibited Th2 polarization in the acute phase of exacerbation and recovered from ARDS through timely ventilator support and subsequent extracorporeal membrane oxygenation. Further investigation regarding the mechanism of immune response in asthma exacerbations associated with pH1N1 infection may elucidate the optimal treatment for asthma.