Antibiotics and Asthma

September 24, 2006 Asthma is a condition in which the airways are inflamed and extra-sensitive to certain stimuli (called triggers). When a trigger is encountered, the muscles around the airways tighten, narrowing the openings through the respiratory passages. In addition, extra mucus is produced by the cells lining the airways, further clogging them. Patients may experience cough, chest tightness, shortness of breath and wheezing. In severe cases, if the symptoms are not reversed, vital organs dont get enough oxygen. The patient can collapse and die. The American Academy of Allergy, Asthma and Immunology estimates 20 million Americans have asthma. About nine million of them are under 18. Each year, about 5,000 Americans die from asthma. Treating Asthma There are several different types of treatment for asthma. Non-steroidal anti-inflammatory medications, like cromolyn or nedocromil, are inhaled medications that help to reduce inflammation on the respiratory passages. Corticosteroids are another form of anti-inflammatory medication thats typically used for more severe asthma cases. They are available in pill or inhaled forms. Because corticosteroids have more side effects, the drugs are typically only used in patients with more severe disease. Medications, called anti-leukotrienes or leukotriene modifiers help reduce asthma symptoms by fighting the chemicals (leukotrienes) in the body that cause asthma symptoms. Another class of medication, bronchodilators, is used during an asthma attack to open the airways and relieve symptoms. Antibiotics and Asthma Patients with chronic asthma sometimes have a hard time controlling symptoms. Researchers at National Jewish Medical Center took tissue samples from the airways of 55 patients with mild to moderate symptoms of chronic asthma; 31 (56 percent) were found to have one of two types of bacteria in their airways: Mycoplasma pneumoniae and Chlamydia pneumoniae. Doctors then randomly divided patients into two groups. Half of them received the antibiotic, clarithromycin, and half received a placebo. All of the patients continued to take their standard asthma medications. After six weeks of treatment, lung function tests were performed on all patients. The investigators found those patients who had evidence of bacterial infection experienced significant improvement in lung function after taking the antibiotic. Antibiotic users who didnt have a bacterial infection had no changes in lung function. The doctors stop short of recommending antibiotics as a treatment for asthma because that could lead to the development of antibiotic-resistant bacterial infections. However, patients who have a hard time controlling their symptoms may want to be tested for the presence of the bacteria. If airway infection is confirmed, treatment with a course of antibiotics may decrease symptoms and improve the patients quality of life. Currently, the only way to test for the bacteria is to perform an invasive bronchoscopy, in which doctors place a tube down the throat and take tissue samples. AUDIENCE INQUIRY For general information on asthma: American Academy of Allergy, Asthma and Immunology, http://www.aaaai.org American Lung Association, http://www.lungusa.org, or contact your local chapter Asthma and Allergy Foundation of America, http://www.aafa.org National Heart, Lung and Blood Institute, http://www.nhlbi.nih.gov BIBLIOGRAPHY "Asthma," Bethesda: National Heart, Lung and Blood Institute, downloaded from website (http://www.nhlbi.nih.gov), August 14, 2006. "Asthma," Milwaukee: American Academy of Allergy, Asthma and Immunology, downloaded from website (http://www.aaaai.org), August 14, 2006. "Asthma Facts and Figures," Washington, DC: Asthma and Allergy Foundation of America, downloaded from website (http://www.aafa.org), August 14, 2006. "Asthma Statistics," Milwaukee: American Academy of Allergy, Asthma and Immunology, downloaded from website (http://www.aaaai.org), August 14, 2006. Bergeron, Celine, M.D., and Louis-Philippe Boulet, M.D., "Structural Changes in Airway Diseases," Chest, April 2006, Vol. 129, No. 4, pp. 1068-1087. Cairns, C., "Acute Asthma Exacerbations," Clinics in Chest Medicine, March 2006, Vol. 27, No. 1, pp. 99-108. Ferrara, G., et al., "Macrolides in the Treatment of Asthma and Cystic Fibrosis," Respiratory Medicine, January 2005, Vol. 99, No. 1, pp. 1-10. Johnston, S., "Macrolide Antibiotics and Asthma Treatment," Journal of Allergy and Clinical Immunology, June 2006, Vol. 117, No. 6, pp. 1233-1236. Johnston, Sebastian, M.D., Ph.D., "The Effect of Telithromycin in Acute Exacerbations of Asthma," The New England Journal of Medicine, April 13, 2006, Vol. 354, No. 15, pp. 1589-1600. Kozyrskyj, Anita, et al., "Antibiotic Treatment of Wheezing in Children with Asthma," Pediatrics, June 2006, Vol. 117, No. 6, pp. 1104-1110. Kraft, Monica, et al., "Mycoplasma pneumoniae and Chlamydia pneumoniae in Asthma," Chest, June 2002, Vol. 121, No. 6, pp. 1782-1788. Little, Frederic, M.D., "Treating Acute Asthma with Antibiotics," The New England Journal of Medicine, April 13, 2006, Vol. 354, No. 15, pp. 1632-1634. Siddiqui, Javeed, M.D., "Immunomodulatory Effects of Macrolides," The American Journal of Medicine, November 8, 2004, Vol. 117, No. 9A, pp. 26S-29S. "Tips to Remember: Asthma Triggers and Management," Milwaukee: American Academy of Allergy, Asthma and Immunology, downloaded from website (http://www.aaaai.org), August 14, 2006. Wenzel, S., "Physiologic and Pathologic Abnormalities in Severe Asthma," Clinics in Chest Medicine, March 2006, Vol. 27, No. 1, pp. 29-40. Research compiled and edited by Barbara J. Fister