Chest
Volume 132, Issue 6, December 2007, Pages 1962-1966
Journal home page for Chest

Translating Basic Research into Clinical Practice
Asthma and Atypical Bacterial Infection

https://doi.org/10.1378/chest.06-2415Get rights and content

A growing body of basic and clinical science implicates the atypical bacterial pathogens Mycoplasma pneumoniae and Chlamydophila (formerly Chlamydia) pneumoniae as potentially important factors in asthma, although their exact contribution to asthma development and/or persistence remains to be determined. Evidence from human studies links both M pneumoniae and C pneumoniae to new-onset wheezing, exacerbations of prevalent asthma, and long-term decrements in lung function, suggesting that these organisms can play an important role in the natural history of asthma. Furthermore, animal models of acute and chronic infection with these organisms indicate that they have the ability to modulate allergic sensitization and pulmonary physiologic and immune response to allergen challenge. These findings raise the possibility that, in at least some individuals with asthma, antibiotic therapy might have a role in long-term treatment. While antibiotics do not currently have a defined role in the treatment of stable patients with chronic asthma, there is emerging evidence that asthma symptoms and biomarkers of airway inflammation can improve when patients who have atypical bacterial infection as a cofactor in their asthma are treated with macrolide antibiotics. Ongoing research into the importance of atypical pathogens in asthma will further elucidate whether these infections are important in disease development or whether their prevalence is increased in asthmatic subjects due to chronic airway inflammation or other, yet unidentified, predisposing factors. Current studies will further define the role of macrolide antibiotics in the treatment of stable patients with asthma, ultimately determining whether these therapeutic agents have a place in asthma management.

Section snippets

The Associations Among M pneumoniae, C pneumoniae, and Asthma

M pneumoniae, which is a common cause of atypical pneumonia and tracheobronchitis,1 attaches to ciliated airway epithelial cells by means of a terminal organelle, infecting the cell and causing epithelial damage and ciliary dysfunction.2 Evidence linking M pneumoniae to new-onset wheezing, exacerbations of prevalent asthma, and long-term decrements in lung function suggest that this organism can play an important role in asthma.

Although sporadic case reports3 have suggested that antecedent

Relevant Animal Models of Atypical Bacterial Infection

Mycoplasma species have been used to study respiratory tract infection in laboratory animals, including mice, leading to insights into mechanisms by which atypical bacteria lead to airway inflammation and responsiveness. Although M pneumoniae is not a natural mouse pathogen, Wubbel and colleagues13 demonstrated that the intranasal introduction of M pneumoniae into BALB/c mice results in acute respiratory tract infection, based on positive broth culture data from fluid specimens from BAL

Is There a Place for Antibiotics in the Treatment of Chronic Asthma?

Antibiotics do not currently play a major role in the treatment of chronic asthma in stable patients. There is emerging evidence, however, that symptoms and markers of airway inflammation may improve when patients who have atypical bacterial infection as a cofactor in their asthma are treated with macrolide antibiotics. In a double-blind protocol, Kraft and colleagues21 treated 55 stable asthmatic subjects with chronic asthma with clarithromycin (500 mg po bid) for 6 weeks. At the end of the

Conclusion

Mounting evidence from both animal and human studies suggests that atypical bacterial infection is an important acquired factor in the pathogenesis and clinical expression of asthma. Ongoing research into the importance of atypical pathogens in asthma will elucidate questions about whether these infections are important in disease development and/or whether their prevalence is increased in asthmatic subjects due to chronic airway inflammation or other, yet unidentified, predisposing factors.

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    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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