Hahn D L
Dean Medical Center, Madison, Wisconsin, USA.
J Fam Pract. 1995 Oct;41(4):345-51.
Some diseases previously believed to be noninfectious, eg, peptic ulcer disease, are now known to be caused by chronic infection. Recently, chronic Chlamydia pneumoniae infection has been suggested as a cause for adult-onset asthma. The purpose of this study was to determine whether antichlamydial treatment would affect the natural history of this disease.
An open-label, before-after treatment trial was performed in a community-based, primary care office. Forty-six patients (mean age 47.7 years; range 17 to 78) with moderate to moderately severe, stable, chronic asthma were treated a median of 4 weeks (range 3 to 9) with oral doxycycline (100 mg twice daily), azithromycin (1000 mg once weekly), or erythromycin (1000 mg daily). Post-treatment pulmonary function and asthma symptoms were compared with baseline values. Follow-up was an average of 6 months (range 1.5 to 36) post-treatment.
Four patients with C pneumoniae respiratory tract infection developed chronic asthma, which disappeared after treatment in each case. Of the remaining 42 seroreactive patients who were treated a mean of 6 years after the development of chronic asthma, one half had either complete remission or major clinical improvement (3 and 18 patients, respectively). This improvement was significantly more likely to occur in patients with early disease (P = .01) and before the development of fixed obstruction (P < .01).
Antimicrobial therapy appeared to "cure" or significantly improve asthma in approximately one half of treated adults, and the response pattern was consistent with chlamydial pathogenesis. C pneumoniae infection in asthma may be clinically important and should be investigated further.
一些先前被认为是非感染性的疾病，如消化性溃疡病，现在已知是由慢性感染引起的。最近，有人提出慢性肺炎衣原体感染是成人哮喘发病的一个原因。本研究的目的是确定抗衣原体治疗是否会影响该疾病的自然病程。
在一个社区基层医疗诊所进行了一项开放标签的治疗前后试验。46例年龄在17至78岁之间、患有中度至中度重度、稳定的慢性哮喘患者，接受了中位时间为4周（3至9周）的口服强力霉素（每日100毫克，分两次服用）、阿奇霉素（每周1000毫克）或红霉素（每日1000毫克）治疗。将治疗后的肺功能和哮喘症状与基线值进行比较。治疗后平均随访6个月（1.5至36个月）。
4例肺炎衣原体呼吸道感染患者发展为慢性哮喘，治疗后均消失。其余42例血清反应阳性患者在慢性哮喘发病后平均6年接受治疗，其中一半患者完全缓解或有显著临床改善（分别为3例和18例）。这种改善在疾病早期患者（P = 0.01）和出现固定性气道阻塞之前（P < 0.01）的患者中更有可能发生。
抗菌治疗似乎使大约一半接受治疗的成年人的哮喘得到“治愈”或显著改善，且反应模式与衣原体发病机制一致。哮喘患者中的肺炎衣原体感染可能具有临床重要性，应进一步研究。
