Chest
Clinical InvestigationsInfectionMycoplasma pneumoniae and Chlamydia pneumoniae in Asthma: Effect of Clarithromycin
Section snippets
Subjects
Fifty-five subjects were recruited via newspaper and radio advertisements from the general Denver, CO, community. The asthmatics fulfilled criteria for asthma,29 exhibiting a provocative concentration of methacholine causing a 20% decline in FEV1 of < 8 mg/mL, and reversibility of lung function by at least 12% with bronchodilator. Exclusion criteria included inpatient status; upper or lower respiratory tract infection within 3 months of study; use of macrolides, tetracyclines, or quinolones
Results
Of fifty-five subjects recruited, 52 subjects were randomized to receive clarithromycin or placebo. Three subjects underwent analysis for mycoplasma and chlamydia, but were excluded from the treatment analysis due to scheduling difficulties (n = 1) and noncompliance (n = 2). On entry into the study, no chest radiographs revealed infiltrates. The mean clarithromycin level in the treatment group was 2.78 ± 0.31 μg/mL.
Discussion
This study illustrates that M pneumoniae or C pneumoniae are present in the airways by PCR in > 55% of the patients with chronic, stable asthma studied. In addition, treatment with clarithromycin improved the FEV1 and reduced airway tissue expression of IL-5, but only in the PCR-positive subjects. There was no change in degree of sinus disease with clarithromycin.
The role of infectious agents in asthma has been shown in exacerbations, and there are now data suggesting a role in pathogenesis.1,2,
ACKNOWLEDGMENT
We gratefully acknowledge the technical assistance of L. Duffy, G. Gambil, J. Glass, and E. Keyser at the University of Alabama at Birmingham; C. Gaydos at Johns Hopkins University; B. Marmion at the Institute of Medical and Veterinary Science, University of Adelaide, Australia; J. Pak and J. Henson at the National Jewish Medical and Research Center, Denver, CO; and the General Clinical Research Center at National Jewish Medical and Research Center and the University of Colorado Health Sciences
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Supported by the American Lung Association Asthma Research Center Grant and Abbott Laboratories.