Severe asthma exacerbation: role of acute Chlamydophila pneumoniae and Mycoplasma pneumoniae infection.
BACKGROUND
Chlamydophila pneumoniae and Mycoplasma pneumoniae are associated with acute exacerbation of bronchial asthma (AEBA). The aim of this study was to evaluate the correlation between these acute bacterial infections and the severity of AEBA.


METHODS
We prospectively analysed consecutive patients admitted to the Emergency Department with acute asthma exacerbation. In every patient peak expiratory flow (PEF) measurement was performed on admission, and spirometry during follow-up. Serology for Chlamydophila and Mycoplasma pneumoniae was performed on admission and after 4-8 weeks.


RESULTS
Fifty-eight patients completed the study. Acute atypical infections (AAI) was observed in 22/58 cases; we found single acute C. pneumoniae in 19 cases, single acute M. pneumoniae in 2 cases, and double acute infection in one case. Functional impairment on admission was greater in patients with AAI than in patients without AAI (PEF 205 +/- 104 L/min vs 276 +/- 117 p = 0.02) and persisted until visit 2 (FEV1% 76.30 +/- 24.54 vs FEV1% 92.91 +/- 13.89, p = 0.002). Moreover, the proportion of patients who presented with severe AEBA was significantly greater in the group with AAI than in the group without AAI (15/22 vs 12/36, p = 0.01; OR 4.29, 95% CI 1.38-13.32).


CONCLUSIONS
Our data suggest an association between acute atypical infection and a more severe AEBA.
Emergency Medicine Department, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Gruppo NIV Policlinico, Milan, Italy. r.cosentini@gmail.com
Roberto
R
Cosentini
Paolo
P
Tarsia
Ciro
C
Canetta
Giovanna
G
Graziadei
Anna Maria
AM
Brambilla
Stefano
S
Aliberti
Maria
M
Pappalettera
Francesca
F
Tantardini
Francesco
F
Blasi
D000208:Acute Disease; D000328:Adult; D001249:Asthma / Q000150:complications*; D023521:Chlamydophila Infections / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008168:Lung / Q000382:microbiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D018410:Pneumonia, Bacterial / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D011019:Pneumonia, Mycoplasma / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013147:Spirometry