Hahn D L, Golubjatnikov R
Arcand Park Clinic, Division of Dean Medical Center, Madison, WI 53704.
J Fam Pract. 1994 Jun;38(6):589-95.
Adult-onset asthma is frequently associated with antecedent respiratory symptoms that could represent either previously undiagnosed asthma or previous lung infections that result in subsequent asthma. To further investigate a reported association of Chlamydia pneumoniae infection and adult reactive airway disease, we looked for evidence of atypical infections in patients with acute wheezing and nonwheezing respiratory illnesses.
Pharyngeal cultures and acute and convalescent serology for C pneumoniae and Mycoplasma pneumoniae were obtained from 131 primary care outpatients (mean age, 36 years) with acute wheezing or nonwheezing respiratory illnesses. Peak flow measurements were obtained in patients with cough or wheeze. Spirometry before and after bronchodilator use was obtained to substantiate the diagnosis of chronic asthma in patients who had persistent wheezing and dyspnea after enrollment.
Twelve (9.2%) of 131 patients were classified as having chronic asthma, 5/12 developed chronic asthma for the first time during the study period. Thirty (22.9%) patients were classified with acute asthmatic bronchitis, and 89 (67.9%) had nonwheezing illness. Two of the newly diagnosed asthmatics met serologic criteria for acute C pneumoniae infection, and one had serologic evidence for acute M pneumoniae infection. Compared with patients with nonwheezing respiratory illnesses, C pneumoniae seroreactivity was significantly (P < .001) associated with both chronic asthma and with acute asthmatic bronchitis.
Acute wheezing illness was encountered frequently in this primary care setting. Although most acute wheezing respiratory illness resolved without obvious chronic sequelae, some patients had persistent symptoms and were diagnosed with chronic asthma. C pneumoniae seroreactivity was associated with both acute and chronic wheezing, suggesting that pulmonary infection with this intracellular pathogen plays a role in the natural history of reactive airway disease.
成人起病的哮喘常与先前的呼吸道症状相关，这些症状可能代表先前未被诊断出的哮喘或先前的肺部感染，进而导致后续的哮喘。为了进一步研究所报道的肺炎衣原体感染与成人反应性气道疾病之间的关联，我们在患有急性喘息和非喘息性呼吸道疾病的患者中寻找非典型感染的证据。
从131名患有急性喘息或非喘息性呼吸道疾病的初级保健门诊患者（平均年龄36岁）中获取咽拭子培养物以及肺炎衣原体和肺炎支原体的急性期和恢复期血清学检查结果。对咳嗽或喘息患者进行峰值流速测量。对入组后仍有持续性喘息和呼吸困难的患者，在使用支气管扩张剂前后进行肺功能测定，以证实慢性哮喘的诊断。
131名患者中有12名（9.2%）被归类为患有慢性哮喘，其中5/12在研究期间首次出现慢性哮喘。30名（22.9%）患者被归类为急性哮喘性支气管炎，89名（67.9%）患有非喘息性疾病。两名新诊断的哮喘患者符合急性肺炎衣原体感染的血清学标准，一名有急性肺炎支原体感染的血清学证据。与非喘息性呼吸道疾病患者相比，肺炎衣原体血清反应性与慢性哮喘和急性哮喘性支气管炎均显著相关（P <.001）。
在该初级保健机构中，急性喘息疾病较为常见。尽管大多数急性喘息性呼吸道疾病在没有明显慢性后遗症的情况下得到缓解，但一些患者仍有持续症状并被诊断为慢性哮喘。肺炎衣原体血清反应性与急性和慢性喘息均相关，表明这种细胞内病原体的肺部感染在反应性气道疾病的自然病程中起作用。
