Serological evidence of infection with Chlamydia pneumoniae is related to the severity of asthma

There is evidence that infection with Chlamydia pneumoniae is associated wi th asthma of recent onset and that it can influence the severity of asthma, This has led to the suggestion that macrolide antibiotics may be useful in the treatment of asthma in subjects infected with C, pneumoniae. This stud y examined the association between immunoglobulin (Ig)G and IgA titres to C , pneumoniae and the severity of asthma, IgG and IgA antibodies to C, pneumoniae were measured in 619 subjects with asthma (18-60 yrs), using the microimmunofluoresence method. Subjects were asked about their use of asthma medicines, symptoms, previous hospitalizati on for asthma, smoking status and age of onset of asthma, In subjects with IgG titres of greater than or equal to 1:64 and/or IgA titres greater than or equal to 1:16 (n=212), spirometry was performed and peak expiratory flow rate (PEFR) and symptoms were recorded twice daily for 4 weeks on a diary card, The use of high dose inhaled steroids was associated with an increase of 74 .1% in the titre of IgG antibodies (p=0.04) and an increase of 70.6% in the titre of IgA antibodies (p=0.0001) when compared with the use of low dose inhaled steroids. There was an inverse association between IgG antibodies a nd forced expiratory volume in one second (FEV1) as a percentage of predict ed in those subjects with elevated IgG and/or IgA. (p=0.04). In this group IgA antibodies were also associated with a higher daytime symptom score (p= 0.04), Higher titres of antibodies to Chlamydia pneumoniae appears to be associate d with markers of asthma severity. This raises the possibility that chronic infection with Chlamydia pneumoniae leads to an increase in the severity o f asthma, Studies aimed at eradicating chronic infection with Chlamydia pne umoniae are necessary to determine whether or not this is the case.