A new discovery suggests that an undetected lung infection could make chronic asthma worse. The good news is, it's treatable.
You wouldn't know it to look at her now, but doctors once gave Diane Cushman Neal only six months to live.
She says, "I couldn’t walk to the bathroom. I actually needed help to get there because I was that winded.”
The 37-year-old has chronic asthma and treatments weren't effective. On a hunch, a doctor at Denver’s National Jewish Medical Center performed a biopsy of her lung.
Diane says, "That was when he found the mycoplasma.”
Diane had pneumonia-causing bacteria in her lungs. That was not making her sick but it was worsening her asthma.
Dr. Richard Martin says, "They’re revving up the allergic response or the inflammation in the airways and the narrowing and swelling of the airways, too.”
The bacteria level is so low that the body doesn’t react to it, so patients don't know they have an infection. When doctors put Diane on antibiotics, she started breathing easier.
She says, "All of a sudden I would be going longer during the day. I would be walking further, I would not be sleeping all the time. And I went, ‘this is working!’”
After finding the bacteria in Diane, Dr. Martin tested other asthma patients. What he discovered surprised him.
He says, "It looks like at least 50 percent of patients may indeed have these bacteria in their airways.”
The study shows antibiotic treatment dramatically improves lung function only in asthma patients with the bacteria; patients like Diane.
She says, "I’m able to exercise. I’ve competed in several different races including finishing a triathlon.”
Even though she still has asthma, her life is back on track.
Right now the only test for the bacteria is a bronchoscopy where doctors put a scope directly into the airways. Dr. Martin is working on a breath test that would make the test easier and available in the doctor's office.
Fast Facts:About 20 million Americans have asthma.
Researchers at National Jewish Medical and Research Center have found more than half of patients with chronic asthma have a bacterial infection in their airways.
Treatment with antibiotics may improve lung function in patients with chronic asthma who are found to have the bacterial infection.
Asthma is a condition in which the airways are inflamed and extra-sensitive to certain stimuli (called triggers). When a trigger is encountered, the muscles around the airways tighten, narrowing the openings through the respiratory passages. In addition, extra mucus is produced by the cells lining the airways, further clogging them. Patients may experience cough, chest tightness, shortness of breath and wheezing. In severe cases, if the symptoms are not reversed, vital organs don’t get enough oxygen. The patient can collapse and die.
The American Academy of Allergy, Asthma and Immunology estimates 20 million Americans have asthma. About nine million of them are under 18. Each year, about 5,000 Americans die from asthma.
There are several different types of treatment for asthma. Non-steroidal anti-inflammatory medications, like cromolyn or nedocromil, are inhaled medications that help to reduce inflammation on the respiratory passages. Corticosteroids are another form of anti-inflammatory medication that’s typically used for more severe asthma cases. They are available in pill or inhaled forms. Because corticosteroids have more side effects, the drugs are typically only used in patients with more severe disease.
Medications, called anti-leukotrienes or leukotriene modifiers help reduce asthma symptoms by fighting the chemicals (leukotrienes) in the body that cause asthma symptoms. Another class of medication, bronchodilators, is used during an asthma attack to open the airways and relieve symptoms.
Antibiotics and Asthma
Patients with chronic asthma sometimes have a hard time controlling symptoms. Researchers at National Jewish Medical Center took tissue samples from the airways of 55 patients with mild to moderate symptoms of chronic asthma; 31 (56 percent) were found to have one of two types of bacteria in their airways: Mycoplasma pneumoniae and Chlamydia pneumoniae.
Doctors then randomly divided patients into two groups. Half of them received the antibiotic, clarithromycin, and half received a placebo. All of the patients continued to take their standard asthma medications. After six weeks of treatment, lung function tests were performed on all patients. The investigators found those patients who had evidence of bacterial infection experienced significant improvement in lung function after taking the antibiotic. Antibiotic users who didn’t have a bacterial infection had no changes in lung function.
The doctors stop short of recommending antibiotics as a treatment for asthma because that could lead to the development of antibiotic-resistant bacterial infections. However, patients who have a hard time controlling their symptoms may want to be tested for the presence of the bacteria. If airway infection is confirmed, treatment with a course of antibiotics may decrease symptoms and improve the patient’s quality of life. Currently, the only way to test for the bacteria is to perform an invasive bronchoscopy, in which doctors place a tube down the throat and take tissue samples.
Web ResourcesAmerican Academy of Allergy, Asthma and Immunology Web site
For general information on asthma:
American Lung Association Web site
Asthma and Allergy Foundation of America Web site
National Heart, Lung and Blood Institute Web site