Possible Role of Infection with Chlamydia Pneumoniae in Determining Severity and Control of Chronic Stable Asthma and in the Induction of Acute Exacerbations in Asthmatics

Background: Asthma is an inflammatory disease of the airways, with a worldwide unexplained increasing incidence. Multiple risk factors are discussed to contribute to the devel-opment of asthma in patients with underlying atopy. Chlamydia pneumoniae (C. pneumoniae) has been discussed as a possible cofactor causing asthma and chronic obstructive pulmonary disease. In addition, it is postulated that Chlamydia pneumoniae may play a vital role in affecting asthma severity and in inducing acute exacerbations. Objectives: Thus the aim of this study was to detect whether infection with Chlamydia pneumoniae is related to asthma severity and affect the control of chronic stable asthmatics. In addition, to detect changes in clinical status and in the frequency of exacerbations on those with positive serology after the intake of specific therapy to Chlamydia. Moreover, to detect a possible role of Chlamydia pneumoniae in induction of acute exacerbations in asthmatics. Methods: Ten patients with acute exacerbation of asthma and 36 cases with chronic stable asthma were serologically examined for presence of IgG antibodies against Chlamydia pneumoniae. Those with evidence of acute or chronic Chlamydia infection were treated with fluorinated 4-quinolone tablets 200mg twice daily for 2 weeks. Serological examination was then repeated and showed evidence of sero-conversion. Asthma severity, clinical status and frequency of exacerbations (in the prior 3 months to this study) were determined in patients with chronic stable asthma and positive serology and compared with those with negative serology to Chlamydia pneumoniae. The same parameters in those sero-positive cases and chronic stable asthma were re-evaluated 3 months after therapy and was compared with those at baseline. Results: Forty six female asthmatics were included in this study. Ten cases suffered from acute exacerbation of asthma, three of them showed serological evidence of acute infection with Chlamydia pneumoniae. Thirty six cases had had chronic stable asthma, 19 of them showed evidence of chronic infection with Chlamydia pneumoniae. Those cases with serological evidence of chronic infection had suffered from frequent exacerbations and required higher doses of therapy than other patients in the same group. After 2 weeks of therapy with quinolones, patients showed sero-conversion, they were followed up for 3 months. Much improvement in clinical status, with decrease in drug dosage used and in the number of exacerbations were reported. Conclusion: Chlamydial infection in asthmatics is related to asthma severity and increase incidence of exacerbations in chronic stable asthmatics. Treatment with quinolones, by improving clinical status and decreasing frequency of exac-erbations act as another evidence of these findings. Moreover, Chlamydia pneumoniae plays a role in the induction of acute exacerbations in asthmatics.