ASTHMA AND CHLAMYDIAL INFECTION - A CASE SERIES

Background. Adult-onset asthma is frequently associated with anteceden t respiratory symptoms that could represent either previously undiagno sed asthma or previous lung infections that result in subsequent asthm a. To further investigate a reported association of Chlamydia pneumoni ae infection and adult reactive airway disease, we looked for evidence of atypical infections in patients with acute wheezing and nonwheezin g respiratory illnesses. Methods. Pharyngeal cultures and acute and co nvalescent serology for C pneumoniae and Mycoplasma pneumoniae were ob tained from 131 primary care outpatients (mean age, 36 years) with acu te wheezing or nonwheezing respiratory illnesses. Peak flow measuremen ts were obtained in patients with cough or wheeze. Spirometry before a nd after bronchodilator use was obtained to substantiate the diagnosis of chronic asthma in patients who had persistent wheezing and dyspnea after enrollment. Results. Twelve (9.2%) of 131 patients were classif ied as having chronic asthma, 5/12 developed chronic asthma for the fi rst time during the study period. Thirty (22.9%) patients were classif ied with acute asthmatic bronchitis, and 89 (67.9%) had nonwheezing il lness. Two of the newly diagnosed asthmatics met serologic criteria fo r acute C pneumoniae infection, and one had serologic evidence for acu te M pneumoniae infection. Compared with patients with nonwheezing res piratory illnesses, C pneumoniae seroreactivity was significantly (P < .001) associated with both chronic asthma and with acute asthmatic br onchitis. Conclusion. Acute wheezing illness was encountered frequentl y in this primary care setting. Although most acute wheezing respirato ry illness resolved without obvious chronic sequelae, some patients ha d persistent symptoms and were diagnosed with chronic asthma. C pneumo niae seroreactivity was associated with both acute and chronic wheezin g, suggesting that pulmonary infection with this intracellular pathoge n plays a role in the natural history of reactive airway disease.