Asthma and atypical bacterial infection
Asthma and atypical bacterial infection
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DOI：
10.1378/chest.06-2415
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发表时间：
2007-12-01
期刊：
影响因子：
9.6
通讯作者：
Martin, Richard J.
中科院分区：
文献类型：
--
作者：
Sutherland, E. Rand;Martin, Richard J.
越来越多的基础和临床科学表明，非典型细菌病原体肺炎支原体和肺炎衣原体（以前称为衣原体）是哮喘的潜在重要因素，尽管它们对哮喘发展和/或持续存在的确切贡献仍有待确定。来自人类研究的证据将肺炎支原体和肺炎衣原体与新发喘息、流行性哮喘的恶化以及肺功能的长期下降联系起来，这表明这些微生物在哮喘的自然史中发挥着重要作用。此外，这些生物体急性和慢性感染的动物模型表明，它们具有调节过敏致敏以及对过敏原挑战的肺部生理和免疫反应的能力。这些发现提出了一种可能性，即至少在一些哮喘患者中，抗生素治疗可能在长期治疗中发挥作用。虽然抗生素目前在稳定的慢性哮喘患者的治疗中没有明确的作用，但有新的证据表明，当非典型细菌感染作为哮喘辅助因素的患者接受大环内酯类抗生素治疗时，哮喘症状和气道炎症的生物标志物可以改善。正在进行的关于非典型病原体在哮喘中的重要性的研究将进一步阐明这些感染在疾病发展中是否重要，或者它们在哮喘受试者中的患病率是否由于慢性气道炎症或其他尚未确定的诱发因素而增加。目前的研究将进一步明确大环内酯类抗生素在稳定哮喘患者治疗中的作用，最终确定这些治疗药物是否在哮喘管理中占有一席之地。
A growing body of basic and clinical science implicates the atypical bacterial pathogens Mycoplasma pneumoniae and Chlamydophila (formerly Chlamydia) pneumoniae as potentially important factors in asthma, although their exact contribution to asthma development and/or persistence remains to be determined. Evidence from human studies links both M pneumoniae and C pneumoniae to new-onset wheezing, exacerbations of prevalent asthma, and long-term decrements in lung function, suggesting that these organisms can play, an important role in the natural history of asthma. Furthermore, animal models of acute and chronic infection with these organisms indicate that they have the ability to modulate allergic sensitization and pulmonary physiologic and immune response to allergen challenge. These findings raise the possibility that, in at least some individuals with asthma, antibiotic therapy might have a role in long-term treatment. While antibiotics do not currently have a defined role in the treatment of stable patients with chronic asthma, there is emerging evidence that asthma symptoms and biomarkers of airway inflammation can improve when patients who have atypical bacterial infection as a cofactor in their asthma are treated with macrolide antibiotics. Ongoing research into the importance of atypical pathogens in asthma will further elucidate whether these infections are important in disease development or whether their prevalence is increased in asthmatic subjects due to chronic airway inflammation or other, yet unidentified, predisposing factors. Current studies will further define the role of macrolide antibiotics in the treatment of stable patients with asthma, ultimately determining whether these therapeutic agents have a place in asthma management.