Azithromycin in treatment of patients with asthma and C. Pneumoniae infection

Chronic C. pneumoniae infection has been suggested as a cause for adult onset of asthma. There are data to suggest that infectious organisms, particularly the atypical bacteria C. pneumoniae, may be involved in asthma pathogenesis. The significance of these organisms is as yet unclear. It is not known whether this organism was allowed to persist after an infection, or was present prior to the development of asthma. The purpose of this study was to determine whether anti-chlamydial treatment with azithromycin will improve asthma symptoms and lung function in asthmatic patients positive for C. pneumoniae. For this purpose, 20 patients (mean age 39.8 years) with mild asthma were treated a median of 8 weeks with azithromycin 1000 mg once weekly. All patients had C. pneumoniae infection detected by Seeplex Multiplex PCR in sputum and positive IgG titre>1:64 and IgA titre>1:16 antibodies against C. pneumoniae. Post treatment lung function, symptom score (cough, wheezing, dyspnea), morning and evening PEF values and β2-agonist use were compared with baseline values. After 8 weeks of treatment with azithromycin there was a significant reduction in symptom score (p<0.001) and a significant improvement in lung function FEV1 (p<0.001), morning and evening PEF values p<0.05 Wilcoxon matched Pairs test. We also found a reduction in β2-agonist use, but it was not statistically significant. Treatment with azithromycin significantly improved asthma symptoms and lung function, indicating that C. pneumoniae may play an important role in enhancing the inflammatory processes in the lower airways.