Infections Cause Asthma

Since the anti-smoking movement began, the death rates from asthma have more than doubled in every age group above five years. This is despite smoking bans and bullying people to quit smoking, as well as improvements in air pollution. The health establishment grasps at lame explanations such as exposure to cockroaches ( which is nothing new), and to the even lamer story that exposure to infections protects against asthma. They claim that life today is too sanitary to develop children's immune systems, but what about the simultaneous increase in the death rates of the elderly? As usual, the anti-smokers' studies ignore the role of infection in asthma.

Mycoplasmas

"The family Mycoplasmataceae contains two genera that infect humans: Mycoplasma and Ureaplasma, which are usually referred to collectively as mycoplasmas. Although there are many species of mycoplasmas, only four are recognized as human pathogens; Mycoplasma pneumoniae, Mycoplasma hominis, Mycoplasma genitalium, and Ureaplasma urealyticum.... The mycoplasmas are the smallest free-living bacteria. They range from 0.2 - 0.8 micrometers and thus can pass through some filters used to remove bacteria. They have the smallest genome size and, as a result, lack many metabolic pathways and require complex media for their isolation. The mycoplasmas are facultative anaerobes, except for M. pneumoniae, which is a strict aerobe. A characteristic feature that distinguishes the mycoplasmas from other bacteria is the lack of a cell wall. Thus, they can assume multiple shapes including round, pear shaped and even filamentous....Colonization of the respiratory tract by M. pneumoniae results in the cessation of ciliary movement. The normal clearance mechanisms of the respiratory tract do not function, resulting in contamination of the respiratory tract and the development of a dry cough.... most children are infected from 2 - 5 years of age but disease is most common in children 5-15 years of age." (Bacteriology - Chapter Nineteen. Mycoplasma and Ureaplasma. Dr. Gene Mayer, University of South Carolina School of Medicine. Accessed 12-15-07.)

Mycoplasma pneumoniae and its role as a human pathogen. KB Waites, DF Talkington. Clin Microbiol Rev 2004 Oct;17(4):697-728. Review. "M. pneumoniae infection leads to deterioration of cilia in the respiratory epithelium, both structurally and functionally. Cells may lose their cilia entirely, appear vacuolated, and show a reduction in oxygen consumption, glucose utilization, amino acid uptake, and macromolecular synthesis, ultimately resulting in exfoliation of all or parts of the infected cells (80, 83) These subcellular events can be translated into some of the clinical manifestations of respiratory tract infection that are associated with this organism, such as the persistent, hacking cough that is so commonly associated with M. pneumoniae." "Mycoplasmas have been detected by PCR in airways even when cultures and serological results are negative, suggesting that low numbers of organisms may evade detection by the immune system." "Lung abnormalities, including reduced pulmonary clearance and airway hyperresponsiveness, may persist for weeks to months after an infection with M. pneumoniae."

Association of Chlamydia pneumoniae (strain TWAR) infection with wheezing, asthmatic bronchitis and adult-onset asthma. DL Hahn, R Dodge, R Golubjatnikov. JAMA 1991;266:225-230.

Chlamydial pneumonia and asthma: a potentially important relationship. RC Bone. JAMA 1991;266:265. No abstract.

Viruses as precipitants of asthma symptoms. I. Epidemiology. PK Pattemore, SL Johnston, PG Bardin. Clin Exp Allergy 1992 Mar;22(3);325-336. Review.

Chlamydia pneumoniae infection and asthma. DL Hahn. The Lancet 1992 May 9;339:1173-1174. Letter. "I would add another possible explanation that has not received the attention it deserves -- increasing worldwide prevalence of Chlamydia pneumoniae infection." No abstract.

Chlamydia trachomatis infection in children with wheezing simulating asthma. M Bavastrelli, M Midulla, D Rossi, M Salzano. Lancet 1992 May 9;339:1174. Letter. "Our data indicate that wheezing may be another clinical expression of C trachomatis infection and that this organism should be sought as a routine in children who wheeze but have no demonstrable allergy and do not respond to the usual anti-asthmatic medications." No abstract.

Viruses as precipitants of asthma symptoms. II. Physiology and mechanisms. PG Bardin, SL Johnston, PK Pattemore. Clin Exp Allergy 1992 Sep;22(9):809-822. Review.

Relationship between viral antibodies and bronchial hyperresponsiveness in 495 unselected children and adolescents. V Backer, CS Ulrick, N Bach-Mortensen, G Glikmann, CH Mordhorst. Allergy 1993 May;48(4):240-247.

Another possible risk factor for airway disease. DL Hahn. Chest 1993 Aug;104(2):649. Letter. "In an editorial that also appeared in the March 1992 issue of Chest, Casterline therefore asks, 'Will the real risk factor for airway disease please stand up?' I have a nomination for a possible culprit, who appears to be trying to get up, but will need some prodding from investigators." No abstract.

Persistent adenoviral infection and chronic airway obstruction in children. V Macek, J Sorli, S Kopriva, J Marin. Am J Respir Crit Care Med 1994 Jul;150(1):7-10.

Acute acerbations of asthma in adults: role of Chlamydia pneumoniae infection. L Allegra, F Blasi, S Centanni, R Cosentini, F Denti, R Raccanelli, P Tarsia, V Valenti. Eur Respir J 1994 Dec;7(12):2165-2168.

Community study of role of viral infections in exacerbations of asthma in 9-11 year old children. SL Johnston, PK Pattemore, G Sanderson, S Smith, F Lampe, L Josephs, P Symington, S O'Toole, SH Myint, DAJ Tyrrell, ST Holgate. BMJ 1995 May 13;310(6989):1225-1229.

Serology of Chlamydia in relation to asthma and bronchial hyperresponsiveness. E Bjornsson, E Hjelm, C Janson, E Fridell, G Boman. Scand J Infect Dis 1996;28(1):63-69.

The relationship between upper respiratory infections and hospital admissions for asthma: a time-tend analysis. SL Johnston, PK Pattemore, G Sanderson, S Smith, MJ Campbell, LK Josephs, A Cunningham, BS Robinson, SH Myint, ME Ward, DA Tyrrell, ST Holgate. Am J Respir Crit Care Med 1996 Sep;154(3 Pt 1):654-660. "We have shown that viruses are associated with 80 to 85% of asthma exacerbations in school-age children in the community...."

Serology of respiratory viruses in relation to asthma and bronchial hyperresponsiveness. E Bjornsson, E Hjelm, C Janson, E Fridell, G Boman. Upsala J Med Sci 1996;101(2):159-168.

Influence of viral and bacterial respiratory infections on exacerbations and symptom severity in childhood asthma. SL Johnston. Pediatr Pulmonol Suppl 1997;16:88-89. Review.

Evidence for Chlamydia pneumoniae infection in steroid-dpendent asthma. DL Hahn, D Bukstein, A Luskin, H Zeitz. Ann Allergy Asthma Immunol 1998 Jan;80(1):45-49.

Can acute Chlamydia pneumoniae respiratory tract infection initiate chronic asthma? DL Hahn, R McDonald. Ann Allergy Asthma Immunol 1998 Oct;81:339-344.

Detection of mycoplasma pneumoniae in the airways of adults with chronic asthma. M Kraft, GH Cassell, JE Henson, H Watson, J Williamson, BP Marmion, CA Gaydos, RJ Martin. Am J Respir Crit Care Med 1998;158:998-1001.

Chronic Chlamydia pneumoniae infection and asthma exacerbations in children. AF Cunningham, SL Johnston, SA Julius, FC Lampe, ME Ward. Eur Respir J 1998 Feb;11(2):345-349.

Viruses and asthmatic syndromes. E Micillo, P Marcatili, S Palmieri, G Mazzarella. Monaldi Arch Chest Dis 1998 Feb;53(1):88-91. Review.

Mechanisms of asthma exacerbation. SL Johnston. Clin Exp Allergy 1998;28(Suppl 5):181-186. Review.

Viruses and asthma. SL Johnston. Allergy 1998;53:922-932. Review.

Chlamydia pneumoniae and asthma. PJ Cook, P Davies, W Tunnicliffe, JG Ayres, D Honeybourne, R Wise. Thorax 1998 Apr;53(4):254-259.

Chlamydia pneumoniae and possible relationship to asthma. Serum immunoglobulins and histamine release in patients and controls. FO Larson, S Norn, CH Mordhorst, PS Skov, N Milman, P Clementsen. APMIS 1998 Oct;106(10):928-934.

Viruses and asthma exacerbations. NG Papadopoulos, SL Johnston. Thorax 1998 Nov;53(11):913-914. Review.

Chlamydia pneumoniae and asthma. F Blasi, L Allegra, P Tarsia. Thorax 1998 Dec;53(12):1094. Letter re Cook 1998.

Chlamydia pneumoniae and asthma. DL Hahn. Thorax 1998 Dec;53(12):1095-1096. Letter re Cook 1998.

Bacterial infection as an important triggering factor in bronchial asthma. AK Oehling. J Investig Allergol Clin Immunol 1999 Jan-Feb;9(1):6-13. Review.

PCR detection of viral nucleic acid in fatal asthma: is the lower respiratory tract a reservoir for common viruses? V Macek, A Dakhama, JC Hogg, FH Green, BK Rubin, RG Hegele. Can Respir J 1999 Jan-Feb;6(1):37-43.

Detection of viral, Chlamydia pneumoniae and Mycoplasma pneumoniae infections in exacerbations of asthma in children. F Freymuth, A Vabret, J Brouard, P Toutain, R Verdon, J Petitjean, S Gouarin, J-F Duhamel, B Guillois. J Clin Virol 1999;13:131-139.

The role of viral and atypical bacterial pathogens in asthma pathogenesis. SL Johnston. Pediatric Pulmonol Suppl 1999;18:141-143. Review.

Not an ideal study. DL Hahn. J Family Pract 1999 Mar;48(3):230. (Letter re Smucny). "In addition to relevant clinical variables, I believe that meaningful studies of acute bronchitis must include objective measures of pulmonary function (including reversibility) and [italics] comprehensive evaluation of microbiologic causes for bronchitis; without subgroup analyses based on these variables, I doubt that clinicians will ever have access to the information they need to provide rational antibiotic prescribing for acute bronchitis in otherwise healthy patients." (No abstract).

Treatment of late-onset asthma with fluconazole. GW Ward Jr, JA Woodfolk, ML Hayden, S Jackson, TAE Platts-Mills. J Allergy Clin Immunol 1999 Sep;104:541-546.

New understanding of disease mechanisms: excitement and caution. DA Stempel. J Allergy Clin Immunol 1999 Sep;104(3 Pt 1):524-525. Editorial re Ward 1999.

Community study using a polymerase chain reaction panel to determine the prevalence of common respiratory viruses in asthmatic and nonasthmatic children. JA West, A Dakhama, MA Khan, S Vedal, RG Hegele. J Asthma 1999 Oct;36(7):605-612.

Chlamydia pneumoniae, asthma, and COPD: what is the evidence? DL Hahn. Ann Allergy Asthma Immunol 1999 Oct;83(4):271-292. Review, with CME examination.

Childhood viral infection and the pathogenesis of asthma and chronic obstructive lung disease. JC Hogg. Am J Respir Crit Care Med 1999 Nov;160(5 Pt 2):826-828. Review.

Respiratory infections and asthma. E Micillo, A Bianco, D D'Auria, G Mazzarella, GF Abbate. Allergy 2000;55 Suppl 61:42-45. Review.

Serologic markers for Chlamydia pneumoniae in asthma. DL Hahn, RW Peeling, E Dillon, R McDonald, P Saikku. Ann Allergy Asthma Immunol 2000 Feb;84(2):227-233.

Serological evidence of infection with Chlamydia pneumoniae is related to the severity of asthma. PN Black, R Scicchitano, CR Jenkins, F Blasi, L Allegra, J Wlodarczyk, BC Cooper. Eur Respir J 2000 Feb;15(2):254-259.

Lack of correlation between Chlamydia pneumoniae antibody titers and adult-onset asthma. JM Routes, HS Nelson, JA Noda, FT Simon. J Allergy Clin Immunol 2000 Feb;105(2 Pt 1):391-392.

Viral and bacterial infections in the development and progression of asthma. JE Gern. J Allergy Clin Immunol 2000 Feb;105(2 Pt 2):S497-S502. Review.

Persistence of viruses in the upper respiratory tract of children with asthma. J Marin, D Jeler-Kacar, V Levsiek, V Macek. J Infect 2000 Jul;41(1):69-72. "Conclusions: The persistent presence of viruses in the upper respiratory tract of asthmatic children shows a possible connection between viral infections and asthma."

The role of atypical organisms in asthma. CM Daian, AH Wolff, L Bielory. Allergy Asthma Proc 2000 Mar-Apr;21(2):107-111. Review.

Chlamydia pneumoniae serological status is not associated with asthma in children or young adults. GD Mills, JA Lindeman, JP Fawcett, GP Herbison, MR Sears. Int J Epidemiol 2000 Apr;29(2):280-284. "The study has not, however, addressed the role this organism may play in specific asthmatic subjects or asthma exacerbations."

[Chlamydia pneumoniae infection in patients with acute bronchitis and bronchial asthma]. M Oshima, Y Awaya, T Fujii, Y Kodomari, M Kuwabara. Arerugi 2000 May;49(5):412-419.

Sensitivity to fungal allergens is a risk factor for life-threatening asthma. PN Black, AA Udy, SM Brody. Allergy 2000 May;55(5):501-504.

[Chronic Chlamydia pneumoniae infection in patients with asthma]. J Niedzwiadek, E Mazur, J Chmielewska-Badora, B Gryglicka, I Wegrzyn-Szkutnik, B Chabros, M Koziol-Montewka, J Milanowski. Pneumonol Alergol Pol 2000;68(5-6):255-260.

The role of bacterial infections in asthma. M Kraft. Clin Chest Med 2000 Jun;21(2):301-313. Review.

The role of viruses in development or exacerbation of atopic asthma. J Schwarze, EW Gelfand. Clin Chest Med 2000 Jun;21(2):279-287. Review.

The role of respiratory viruses in acute and chronic asthma. A Tuffaha, JE Gern, RF Lemanske. Clin Chest Med 2000 Jun;21(2):289-300. Review.

Specific and nonspecific obstructive lung disease in childhood: causes of changes in the prevalence of asthma. TA Platts-Mills, MC Carter, PW Heymann. Environ Health Perspect 2000 Aug;108 Suppl 4:725-731. Review.

Chlamydia pneumoniae antibodies and adult-onset asthma. DL Hahn. J Allergy Clin Immunol 2000 Aug;106(2). Letter re Routes 2000.

[Impact of Chlamydia pneumoniae infections on asthma]. G Jebrak, O Brugiere, ML Uffredi. Presse Med 2000 Sep 9;29(25):1425-1431. Review.

[Percentage of asthmatic patients with acute bronchitis and Chlamydia pneumoniae seropositivity]. J Orfila, P Godard. Presse Med 2000 Sep 9;29(25):1439-1441.

Chlamydia pneumoniae and the lung. MR Hammerschlag. Eur Respir J 2000 Nov;16(5):1001-1007. Comment.

[The role of fungal allergy in bronchial asthma]. K Akiyama. Nippon Ishinkin Gakkai Zasshi 2000;41(3):149-155. Review.

Prevalence of Chlamydia pneumoniae in acute respiratory tract infection and detection of anti-Chlamydia pneumoniae-specific IgE in Japanese childen with reactive airway disease. S Ikezawa. Kurume Med J 2001;48(2):165-170.

Persistent airflow limitation in adult-onset nonatopic asthma is associated with serologic evidence of Chlamydia pneumoniae infection. A ten Brinke, JT van Dissell, PJ Sterk, AH Zwinderman, KF Rabe, EH Bel. J Allergy Clin Immunol 2001 Mar;107(3):449-454.

A link between chronic asthma and chronic infection. RJ Martin, M Kraft, HW Chu, EA Berns, GH Cassell. J Allergy Clin Immunol 2001 Apr;107(4):595-601. 31/55 asthma patients were PCR+ for Mycoplasma, vs 1/11 normal controls.

Increased frequency of Chlamydia pneumoniae antibodies in patients with asthma. M Gencay, JJ Rudiger, M Tamm, M Soler, AP Perruchoud, M Roth. Am J Respir Crit Care Med 2001 Apr;163(5):1097-1100. "The worldwide increase in asthma incidences and the impact of the disease on public health care have led to new investigations of the cause of the disease. Besides well-defined environmental causes [SIC- meaning those "defined" by confounding in the worthless "lifestyle questionnaire" studies foisted on the world by the American Lung Association], accumulating evidence indicates that respiratory tract infections play an important role in the pathogenesis of asthma."

Host immune response to Chlamydia pneumoniae heat shock protein 60 is associated with asthma. T Huittinen, D Hahn, T Anttila, E Wahlstrom, P Saikku, M Leinonen. Eur Respir J 2001 Jun;17(6):1078-1082. C pneumoniae Hsp60 IgA antibodies and asthma, p = 0.02.

Trial of roxithromycin in subjects with asthma and serological evidence of infection with Chlamydia pneumoniae. PN Black, F Blasi, CR Jenkins, R Scicchitano, GD Mills, AR Rubinfeld, RE Ruffin, PR Mullins, J Dangain, BC Cooper, DB David, L Allegra. Am J Respir Crit Care Med 2001 Aug 15;164(4):536-541. "Six weeks of treatment with roxithromycin led to improvements in asthma control but the benefit was not sustained."

Viral infection may be linked to asthma deaths. Medscape - Reuters Health 2001 Sep 18. "[A]lthough there was no difference in viral burden or the prevalence of viral infection between the two groups, there was 'an expanded CD8+ T-cell population, dominated by activated cytotoxic CD8+ lymphocytes' in those who died from asthma."

Chlamydia pneumoniae and severity of asthma. HL Von, T Vasankari, K Liippo, E Wahlstrom, M Puolakkainen. Scand J Infect Dis 2002;34(1):22-27. "Severe and moderate asthma were significantly associated with elevated IgA antibody levels to C. pneumoniae suggestive of chronic infection."

Chlamydia pneumoniae immunoglobulin A reactivation and airway inflammation in acute asthma. PA Wark, SL Johnston, JL Simpson, MJ Hensley, PG Gibson. Eur Respir J 2002 Oct;20(4):834-840. "the serological features suggest that Chlamydia pneumoniae reactivation may trigger neutrophilic airway inflammation in acute asthma."

Is asthma an infectious disease?: Thomas A. Neff lecture. RF Lemanske Jr. Chest 2003 Mar;123(3 Suppl):385S-90S. Review. "The data to support a potential role for these agents in asthma is most convincing for C pneumoniae. The major impedance in studying the contribution of this organism to asthma pathogenesis has been the lack of a sensitive, specific, reliable, and convenient diagnostic laboratory test."

Anti-Chlamydia pneumoniae heat shock protein 10 antibodies in asthmatic adults. F Betsou, JM Sueur, J Orfila. FEMS Immunol Med Microbiol 2003 Mar 20;35(2):107-111. In 160 asthmatic adults and 88 non-asthmatic controls, "An association was observed between the presence of anti-Chsp10 antibodies and adult onset asthma."

The development of asthma in children infected with Chlamydia pneumoniae is dependent on the modifying effect of mannose-binding lectin. A Nagy, GT Kozma, M Keszei, A Treszl, A Falus, C Szalai. J Allergy Clin Immunol 2003 Oct;112(4):729-734. 139 children with asthma and 174 healthy controls. "Among asthmatic children carrying variant MBL alleles, there were significantly more patients with positive results for C pneumoniae-specific IgG than among control children with variant MBL genotypes (63.7% vs 40.7% of asthmatic vs control children, respectively; odds ratio adjusted for age and sex, 2.21; 95% CI, 1.10-4.41; P =.02). Infected children with variant MBL alleles were found to have a higher risk of asthma development than infected children with normal MBL genotype. This risk was especially high in children with chronic or recurrent infection (positive results for both IgA and IgG; adjusted odds ratio, 5.38; 95% CI, 1.75-14.36; P =.01), but no increased risk was seen in children with current C pneumoniae infection (positive results for IgM)."

Chlamydia pneumoniae infection and inflammation in adults with asthma. T Savykoski, T Harju, M Paldanius, H Kuitunen, Bloigu, E Wahlstrom, P Rytila, V Kinnula, P Saikku, M Leinonen. Respiration 2004 Mar-Apr;71(2):120-125. Serum and sputum samples from 103 asthma patients and 30 healthy volunteers. "The asthma patients, especially those with moderate asthma, had higher serum IgA antibody levels to CpHsp60 than the healthy controls (test for trend, p = 0.05), whereas antibody levels to CpEB antigen did not differ between the study groups. CRP levels were higher in both asthma groups compared to the control group and moreover, the patients with moderate asthma had higher CRP levels than those with mild asthma (test for trend, p < 0.01). The subjects with a slightly elevated CRP level, defined as > or =1.8 mg/l, had higher CpEB IgA (p = 0.001), CpEB IgG (p = 0.008) and CpHsp60 IgA (p = 0.023) antibody levels in serum compared to the subjects with lower CRP levels."

Seroprevalence of Mycoplasma pneumoniae and Chlamydia pneumoniae in stable asthma and chronic obstructive pulmonary disease. SJ Park, YC Lee, YK Rhee, HB Lee. J Korean Med Sci 2005 Apr;20(2):225-228. "Seroprevalences of M. pneumoniae and C. pneumoniae in the asthma group (11.1% and 8.3%, respectively) were higher than in the control group (4.4% and 2.2%, respectively) without statistical significance. The seroprevalence of M. pneumoniae in the COPD group (16.9%) was significantly higher than in the control group, and the seroprevalence of C. pneumoniae in the COPD group (3.4%) was higher than in the control group without statistical significance." 140 patients in all.

[Is there a link between chronic chlamydial infection and childhood asthma?] J Tyl. Med Wieku Rozwoj 2004 Apr-Jun;8(2 Pt 2):411-417. "Results were positive for Chlamydia pneumoniae in 7/51 children with asthma compared with 1/36 controls. Specific IgA anti-Chlamydia trachomatis antibodies were detected in 2/51 patients with asthma and in one of the 36 controls. Infected children, more often than asthmatics without specific chlamydial IgA, suffered from more severe forms of asthma and required multiple-drug therapy, but none of the differences appeared statistically significant."

Use of quantitative and objective enzyme immunoassays to investigate the possible association between Chlamydia pneumoniae and Mycoplasma pneumoniae antibodies and asthma.T Tuuminen, I Edelstein, A Punin, N Kislova, L Stratchounski. Clin Microbiol Infect 2004 Apr;10(4):345-348. "Sera from 150 consecutive patients with established asthma and 150 matched controls were examined for Chlamydia pneumoniae IgG and IgA with commercially available enzyme immunoassays (EIAs) detecting immune response solely to surface proteins of elementary bodies. The assays were also modified to measure combined immune response to surface proteins and family-specific lipopolysaccharide antigen. Mycoplasma pneumoniae IgG and IgA were measured with new commercial EIAs utilising P1-enriched protein fraction as an antigen. No statistically significant differences between the patient groups in terms of prevalence or levels of antibodies to either organism were found with these methods."

Mycoplasma pneumoniae and asthma in children. S Biscardi, M Lorrot, E Marc, F Moulin, B Boutonnat-Faucher, C Heilbronner, JL Iniguez, M Chaussain, E Nicand, J Raymond, D Gendrel. Clin Infect Dis 2004 May 15;38(10):1341-1346. "Of 119 patients with previously diagnosed asthma, acute M. pneumoniae infection was found in 24 (20%) and C. pneumoniae infection was found in 4 (3.4%) of the patients during the current exacerbation. Of 51 patients experiencing their first asthma attack, acute M. pneumoniae infection was proven in 26 (50%) of the patients (P<.01) and C. pneumoniae in 4 (8.3%). In the control group of 152 children with stable asthma or rhinitis, 8 (5.2%) had M. pneumoniae infection (P<.005). Of the 29 patients experiencing their first asthma attack and infected with M. pneumoniae or C. pneumoniae, 18 (62%) had asthma recurrences but only 6 (27%) of the 22 patients who did not have such infections had asthma recurrences (P<.05)."

Chlamydophila pneumoniae and Mycoplasma pneumoniae in respiratory specimens of children with chronic lung diseases. N Teig, A Anders, C Schmidt, C Rieger, S Gatermann. Thorax 2005 Nov;60(11):962-966. "We investigated nasal brush specimens and induced sputum from 38 children with stable chronic lung disease (asthma, n = 26; chronic bronchitis n = 12) and from 42 healthy controls for the presence of M pneumoniae or C. pneumoniae DNA by polymerase chain reaction (PCR) using nested primers. RESULTS: None of the controls but 23.6% and 10.5% of the children with lung disease had positive PCR for C pneumoniae (p = 0.001) and M pneumoniae (p = 0.044) respectively."

Bronchial asthma and Chlamydia pneumoniae antibodies in children aged 4-8 years in Olomouc district. F Kopriva, J Szotkowska, M Zapalka. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2005 Dec;149(2):289-291. "In a group of 83 atopic children with chronic cough, IgM and IgG antibodies to C. pneumoniae were demonstrated in 20 children (24 %). Among children with bronchial asthma, positive antibody was present in 29 children (44 %; /p = 0,052/); of this number, 24 (36 %; /p = 0,06/) had IgM and IgG antibodies while 5 children (8 %) had IgA and IgG antibodies against C. pneumoniae. A group of non-atopic children with non-specific symptoms included 38 children (16 %) with antibody positivity; 27 children (11 %) with IgM and IgG antibodies and 11 children (5 %) with IgA and IgG antibodies against C. pneumoniae. CONCLUSIONS. Asthma in children was associated with elevated levels of IgM and IgG antibodies to C. pneumoniae."

The effect of telithromycin in acute exacerbations of asthma. SL Johnston, F Blasi, PN Black, RJ Martin, DJ Farrell, RB Nieman; TELICAST Investigators. N Engl J Med 2006 Apr 13;354(15):1589-1600. Randomized controlled trial in 278 adults with diagnosed asthma, enrolled within 24 hours after an acute exacerbation. "Of the two prespecified primary outcomes, only asthma symptoms showed a significantly greater reduction among patients receiving telithromycin than among those receiving placebo." There was no change in morning peak expiratory flow. "Although 61 percent of patients had evidence of infection with C. pneumoniae, M. pneumoniae, or both, there was no relationship between bacteriologic status and the response to asthma treatment."

[Evaluation of association between an acute attack of childhood bronchial asthma and Chlamydia pneumoniae infection] Y Jiang, XL Liu, FQ Xing, JS Yang, H Tu. Zhongguo Dang Dai Er Ke Za Zhi 2006 Apr;8(2):113-114. "Anti-CP IgM was demonstrated in 22 cases (18.3%) and anti-CP IgG was demonstrated in 32 cases (26.7%) out of the 120 asthmatic patients. The incidence of CP infection in asthmatic children was significantly higher than that in healthy controls (3.7%) (P < 0.01)."

Pathogenic bacteria and viruses in induced sputum or pharyngeal secretions of adults with stable asthma. TH Harju, M Leinonen, J Nokso-Koivisto, T Korhonen, R Räty, Q He, T Hovi, J Mertsola, A Bloigu, P Rytilä, P Saikku. Thorax 2006 Jul;61(7):579-584. "Sputum samples from two of the 30 healthy controls (6.7%), five of 53 patients with mild asthma (9.4%), and eight of 50 with moderate asthma (16.0%) were positive for rhinovirus. Rhinovirus positive asthmatic subjects had more asthma symptoms and lower forced expiratory volume in 1 second (FEV(1)) (79% predicted) than rhinovirus negative cases (93.5% predicted; p = 0.020). Chlamydia pneumoniae PCR was positive in 11 healthy controls (36.6%), 11 mild asthmatics (20.8%), and 11 moderate asthmatics (22%), and PCR positive asthmatics had lower FEV(1)/FVC than negative cases (78.2% v 80.8%, p = 0.023). Bordetella pertussis PCR was positive in 30 cases: five healthy controls (16.7%), 15 mild asthmatics (28.3%), and 10 moderate asthmatics (20%). Bordetella pertussis positive individuals had lower FEV(1)/FVC (77.1% v 80.7%, p = 0.012) and more asthma symptoms than B pertussis negative cases."

Association between Chlamydia pneumoniae antibodies and wheezing in young children and the influence of sex. E Normann, J Gnarpe, B Wettergren, C Janson, M Wickman, L Nordvall. Thorax 2006 Dec;61(12):1054-1058. In 1581 four-year-olds, "In girls, the occurrence of anti-Cpn IgG was associated with wheezing at the ages of 1, 2, and 4 years (odds ratios (ORs) 3.41 (95% confidence interval (CI) 1.46 to 7.96), 2.13 (95% CI 1.02 to 4.44), and 2.01 (95% CI 1.14 to 3.54), respectively), and even higher ORs were observed for each age category when only high level antibody responses to Cpn were analysed. At the time of blood sampling the association between anti-Cpn IgG and wheezing was restricted to girls without atopic sensitisation (OR 2.39 (95% CI 1.25 to 4.57). No associations with wheezing were detected in boys, in whom IgE sensitisation was inversely associated with the presence of anti-Cpn IgG (OR 0.49 (95% CI 0.26 to 0.90)). CONCLUSIONS: This study suggests an association between evidence of earlier Cpn infection and a history of wheezing in young girls."

Role of viruses and atypical bacteria in asthma exacerbations among children in Oporto (Portugal). M João Silva, C Ferraz, S Pissarra, MJ Cardoso, J Simões, A Bonito Vítor. Allergol Immunopathol (Madr) 2007 Jan-Feb;35(1):4-9. "In 54 eligible children, 37 nasal samples were obtained. Infectious agents were detected in 78 % of the patients. Rhinovirus was detected in 70.3 %, Mycoplasma pneumoniae in 16.2 %, enterovirus in 10.8 %, and Chlamydia pneumoniae in 2.7 %. Coinfection was identified in 21.6 % of the samples. There was no significant correlation between current treatment status, severity of asthma or exacerbations and the isolated agents."

Is there any relationship between asthma and asthma attack in children and atypical bacterial infections; Chlamydia pneumoniae, Mycoplasma pneumoniae and helicobacter pylori. A Annagür, SG Kendirli, M Yilmaz, DU Altintas, A Inal. J Trop Pediatr 2007 Oct;53(5):313-318. "Seventy-nine asthmatic children (46 males, aged 5-15 years) were included in study. The study group was divided into two groups: group 1 consisted of 37 children with asthma attacks and group 2 consisted of 42 children with stable asthma. As a control group we studied 36 healthy children.... Mycoplasma IgM and Chlamidia IgM were positive in 8.1% (3 patients) and 18.9% (7 patients) of group 1 patients, respectively. There was a statistically significant difference for Mycoplasma IgM (p = 0.031) and Chlamidia IgM (p = 0.03) between group1 and other two groups."

Modulation of pulmonary dendritic-cell function during mycobacterial infection. MM Anis, SA Fulton, SM Reba, Y Liu, CV Harding, WH Boom. Infect Immun 2008 Feb;76(2):671-677. "Interestingly, during peak mycobacterial infection, CD11chi MHChi lung DCs had slightly decreased chemotaxis toward the CCR7 ligand CCL21 and less efficiency in activating naive CD4+ T cells than DCs from mice during late-stage infection, when few bacilli are found in the lung."

Steroid resistance

Latent adenoviral infection modifies the steroid response in allergic lung inflmmation. K Yamada, WM Elliott, S Hayashi, R Brattsand, C Roberts, TZ Vitalis, JC Hogg. J Allergy Clin Immunol 2000 Nov;106(5):844-851.

Interactions between allergic inflammation and respiratory viral inflammations. PC Avila. J Allergy Clin Immunol 2000 Nov;106(5):829-831. Editorial re Yamada.

Molecular mechanisms of decreased steroid responsiveness induced by latent adenoviral infection in allergic lung inflammation. K Yamada, WM Elliott, R Brattsand, A Valeur, JC Hogg, S Hayashi. J Allergy Clin Immunol 2002 Jan;109(1):35-42. In this guinea pig study, latent adenovirus infection inhibited the anti-inflammatory effects of glucocorticoids.

Pertussis (whooping cough) causes persistent cough in children and adults

Anti-smoker studies never take this infection into consideration. The official incidence figures are up to 80 times too low, so this is an important source of confounding.

Bordetella pertussis, Bordetella parapertussis, Mycoplasma pneumoniae, Chlamydia pneumoniae and persistent cough in children. HO Hallander, J Gnarpe, H Gnarpe, P Olin. Scand J Infect Dis 1999;31(3):281-286.

Molecular aspects of Bordetella pertussis pathogenesis. C Locht. Int Microbiol 1999 Sep;2(3):137-144. Review.

Bordetella pertussis and chronic cough in adults. NH Birkeback, M Kristiansen, T Seefeldt, J Degn, A Moller, I Heron, PL Andersen, JK Moller, L Ostergard. Clin Infect Dis 1999 Nov;29(5):1239-1242.

Serological evidence of pertussis in patients presenting with cough at a general practice in Birmingham. E Miller, DM Fleming, LA Ashworth, DA Mabbett, JE Vurdien, TS Elliott. Commun Dis Public Health 2000 Jun;3(2):132-134. "Fifty-eight cases of pertussis in this population and time period was equivalent to an annual incidence of 330 per 100,000, whereas statutory notifications of pertussis in England and Wales suggest an incidence of less than 4 per 100,000 in the same period."

Frequency of serologic evidence of Bordetella infections and mixed infections with other respiratory pathogens in university students with cough illnesses. LA Jackson, JD Cherry, SP Wang, JT Grayston. Clin Infect Dis 2000 Jul;31(1):3-6. "Our findings indicate that bordetella infections are common in young adults with cough illnesses (incidence, 9%), and a surprising number of these are mixed infections with other respiratory pathogens."

Costs of illness due to Bordetella pertussis in families. LH Lee, ME Pichichero. Arch Fam Med 2000 Nov-Dec;9(10):989-996.

Pertussis is a frequent cause of prolonged cough illness in adults and adolescents. LD Senzilet, SA Halperin, JS Spika, M Alagaratnam, A Morris, B Smith. Clin Infect Dis 2001 Jun 15;32(12):1691-1697. 48/442 patients (19.9%) with prolongued cough illness had laboratory-confirmed or laboratory evidence of pertussis involvement.

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cast 01-24-08