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Bronchial hyperresponsiveness and bacterial respiratory infections
M Cazzola1, M G Matera, F Rossi
1Department of Pulmonary Medicine, A. Cardarelli Hospital, Naples, Italy.
Insights
Bacterial respiratory infections can worsen asthma and chronic obstructive pulmonary disease (COPD) by increasing airway reactivity. Antibiotics may help manage bacterial infections, potentially reducing airway hyperresponsiveness in patients with asthma and COPD.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Allergy and Immunology
Background:
- Bacterial respiratory tract infections are implicated in bronchospasm and the progression of chronic obstructive pulmonary disease (COPD).
- Conditions like bronchiectasis, cystic fibrosis, and croup exhibit exaggerated airway reactivity, potentially influenced by bacterial presence.
- Bacterial inhalation, including Haemophilus influenzae, has been linked to bronchial obstruction.
Purpose of the Study:
- To investigate the prevalence of bacterial infections during acute asthma exacerbations.
- To assess the role of antibiotic therapy in managing bacterial respiratory infections and associated airway hyperreactivity in asthmatic patients.
Main Methods:
- A multicenter study of 193 patients with acute asthma exacerbation between January 1989 and June 1990.
- Bacterial identification in sputum samples from patients.
- Evaluation of antibiotic treatment (cefaclor) in a subset of 12 patients with high airway reactivity.
Main Results:
- Bacteria were detected in the sputum of 52% of patients during acute asthma exacerbations.
- Commonly isolated bacteria included Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, Moraxella catarrhalis, and H. influenzae.
- A 10-day course of cefaclor in 12 patients resulted in microbiologic cure and a slight, though not statistically significant, change in airway reactivity.
Conclusions:
- Antibiotic therapy plays a role in controlling bronchial hyperreactivity secondary to bacterial respiratory infections in asthmatic patients.
- The efficacy of antibiotics is most apparent after the resolution of airway inflammation.
- Strategies to minimize airway reactivity are crucial for preventing or reversing respiratory failure in asthma and COPD exacerbations.
Abstract:
Some studies suggest a potential role for bacterial respiratory tract infections in the development of bronchospasm and the progression of chronic obstructive pulmonary disease (COPD). Patients with bronchiectasis or cystic fibrosis have exaggerated airway reactivity; croup in children can also cause exaggerated upper and lower airway responsiveness. Bronchial obstruction after inhalation of Haemophilus influenzae and other bacteria has been reported. Between January 1989 and June 1990 we and two other centers studied 193 patients suffering from acute exacerbation of asthma. Fifty-two (27%) of these patients had bacteria in their sputum. Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, Moraxella catarrhalis, and H influenzae were the most commonly isolated bacterial species. Antibiotics may be of value in the treatment of infective lung disease, not only by killing bacteria but also by preventing increases in bacterial histamine levels within the lung airways. Moreover, an antibiotic of proven efficacy can reduce airway reactivity in patients with bacterial exacerbations of COPD or bronchial asthma. In 12 patients with acute bacterial exacerbation of asthma and high airway reactivity to methacholine, a ten-day course of treatment with cefaclor and existing bronchodilators induced microbiologic cure and a slight but nonsignificant change in airway reactivity in nine patients. Antibiotic therapy has a minor but clear role in the control of acquired bronchial hyperreactivity during bacterial respiratory infections in asthmatic patients; however, because of airway inflammation, an antibiotic's efficacy is evident only when the inflammatory process subsides. Approaches designed to minimize airway reactivity may contribute to the prevention or reversal of respiratory failure during exacerbation of COPD and bronchial asthma.