Infectious Asthma: Understanding the Complex Interplay between Infections and Asthma

Greetings to Members and Subscribers of the World Asthma Foundation

As a chronic respiratory disease, asthma affects millions of individuals worldwide, causing inflammation and narrowing of the airways, leading to breathing difficulties, coughing, and wheezing. Asthma can have a significant impact on individuals and their families, as well as the broader society, due to the high cost of treatment and the potential for reduced quality of life. Recent research has explored the relationship between infections and asthma, with a focus on the role of infections in exacerbating asthma symptoms. The World Asthma Foundation aims to provide a comprehensive review of the latest research related to infections and asthma, and to explore potential strategies for managing and preventing infection-related asthma.

Introduction

While the exact causes of asthma are not fully understood, researchers have identified several factors that can contribute to the development and exacerbation of the disease, including infections. Infections can be caused by a range of pathogens, including respiratory viruses, bacterial infections, and fungi, among others. Although the relationship between infections and asthma has been widely studied, a fundamental question that remains to be addressed is whether infections may be responsible for creating the asthmatic predisposition in the first place. Understanding the relationship between infections and asthma is critical for the management and prevention of asthma.

Infectious Agents and Asthma

Recent studies have shown that various infectious agents may contribute to the development and exacerbation of asthma. Respiratory viral infections, particularly those caused by rhinovirus and respiratory syncytial virus, have been linked to the development of childhood asthma. In addition, certain bacterial infections, such as those caused by Streptococcus pneumoniae and Haemophilus influenzae, may also contribute to the development of asthma.

More recent research has also implicated Chlamydia pneumoniae, Staphylococcus aureus, and Candida albicans as potential infectious agents linked to the development and exacerbation of asthma.

Chlamydia pneumoniae has been associated with a specific type of asthma, known as Chlamydia pneumoniae-mediated asthma. Staphylococcus aureus has been linked to the development of severe asthma, particularly in patients with atopic dermatitis. Candida albicans has been linked to the development and exacerbation of asthma, particularly in patients with severe asthma or fungal sensitization.

Antibiotics and Asthma

In addition to preventive strategies, such as avoidance and good hygiene practices, antibiotics may also have a role in the management of severe asthma. Azithromycin, an antibiotic, has been shown to be effective in reducing asthma exacerbations. However, the exact mechanism of action is not established, so it is unknown whether azithromycin works vis its antibiotic effects or because of some non-infectious anti-inflamatory activity. While most asthma specialists believe that azithromycin works because it is an anti-inflammatory, recent research suggests that it may be due to its antimicrobial effects against chronic atypical respiratory infections such as Chlamydia pneumoniae and Mycoplasma pneumoniae. It is important to note that a growing amount of research reflects that antibiotic use can contribute to dysbiosis and the development of asthma, and appropriate antibiotic use is necessary to prevent this potential negative impact on the microbiome.

Antifungal Therapy and Asthma

Fungi, particularly Candida albicans and Aspergillus fumigatus, have been implicated in the development and exacerbation of asthma. Fungal sensitization has been associated with more severe asthma and poorer asthma control. Some studies have shown that antifungal therapy may be effective in reducing asthma symptoms and improving lung function in individuals with fungal sensitization. However, the evidence for antifungal therapy in asthma is limited and further research is needed to fully understand the potential benefits and risks of this treatment. Moreover, antifungal therapy raises issues about efficacy and resistance, as improper use of antifungal medications can contribute to the development of drug-resistant fungi. Therefore, accurate diagnosis and appropriate use of antifungal therapy are necessary to prevent the development of drug-resistant fungi and ensure the safe and effective management of asthma.

Microbiome and Asthma

Recent research has also explored the role of dysbiosis, or an imbalance in the microbiome, in the development and exacerbation of asthma. The microbiome may influence asthma through several potential mechanisms, including modulation of the immune system and production of metabolites. While microbiome-targeted therapies, such as probiotics and fecal microbiota transplantation, may have potential as treatments for asthma, it is important to note that overuse of antibiotics can contribute to dysbiosis and the development of asthma. Therefore, appropriate antibiotic use is essential to prevent antibiotic overuse and the potential negative impact on the microbiome. Furthermore, the exact mechanisms by which dysbiosis influences asthma are not fully understood and require further research.

Challenges and Barriers

While significant progress has been made in understanding the relationship between infections and asthma, challenges and barriers remain. The lack of well-established classification and terminology for different types of infectious asthma is one such challenge. Further research is needed to develop a more comprehensive understanding of the complex interplay between infections and asthma, including the identification of specific types of infections that are most likely to trigger asthma exacerbations and the potential role of infections in creating the asthmatic predisposition.

Key Takeaway

  • Infections, particularly respiratory infections, have been linked to the development and exacerbation of asthma. Future research is needed to fully understand the complex interplay between infections and asthma.
  • Dysbiosis, or an imbalance in the microbiome, may contribute to the development and exacerbation of asthma.
  • Overuse of antibiotics can contribute to dysbiosis and the development of asthma. Therefore, appropriate antibiotic use is essential to prevent antibiotic overuse and the potential negative impact on the microbiome.
  • Fungi, particularly Candida albicans and Aspergillus fumigatus, have also been implicated in the development and exacerbation of asthma.
  • Antifungal therapy may be effective in reducing asthma symptoms and improving lung function in individuals with fungal sensitization, but further research is needed to fully understand the potential benefits and risks of this treatment.
  • Improper use of antifungal medications can contribute to the development of drug-resistant fungi, so accurate diagnosis and appropriate use of antifungal therapy are necessary to prevent the development of drug-resistant fungi and ensure the safe and effective management of asthma.
  • The exact mechanisms by which infections, dysbiosis, and fungi influence asthma are not fully understood and require further research.
  • It is essential to accurately diagnose and manage asthma to reduce the risk of exacerbations and improve quality of life.
  • This includes identifying and managing potential triggers, such as infections and dysbiosis.
  • Collaboration between researchers, healthcare providers, and patients is necessary to advance our understanding of the complex interplay between infections, dysbiosis, fungi, and asthma and develop effective strategies for managing this challenging disease.

Call to Action: Improving Diagnostic Tools and Methodology for Asthma

While significant progress has been made in understanding the relationship between infections and asthma, there are still challenges and barriers to identifying and managing the infectious agents that contribute to asthma development and exacerbation. One of the biggest challenges is the lack of well-established diagnostic tools and methodology for identifying the specific types of infections that are most likely to trigger asthma exacerbations.

Therefore, the World Asthma Foundation must call for increased research into developing and validating new diagnostic tools and methodology for infectious asthma. This research should focus on identifying new biomarkers that can be used to distinguish between different types of infectious asthma, and on developing new diagnostic tests that are highly sensitive and specific for detecting these biomarkers.

In addition, the World Asthma Foundation should advocate for increased funding for research into infectious asthma, including research into the mechanisms by which infectious agents contribute to asthma development and exacerbation, and the potential role of dysbiosis and the microbiome in infectious asthma.

Improved diagnostic tools and methodology for infectious asthma will be critical for developing more effective strategies for managing and preventing this challenging disease. By supporting research in this area, the World Asthma Foundation can make a significant impact on improving the lives of individuals living with asthma.

Future reports will delve further into the challenges and opportunities related to developing improved diagnostic tools and methodology for infectious asthma, highlighting new research and potential strategies for addressing this critical need.

Let’s work together to improve our understanding of infectious asthma and develop better ways to manage and prevent it.

Conclusion

Asthma is a complex respiratory disease with various factors that can contribute to its development and exacerbation, including infections.

A comprehensive understanding of the complex interplay between infections and asthma is critical for the management and prevention of asthma.

Further research is needed to develop more effective strategies for managing and preventing infection-related asthma.

As the World Asthma Foundation, it is essential to continue supporting and encouraging research into the relationship between infections and asthma, to improve the lives of those living with asthma.

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Infection-mediated asthma: etiology, mechanisms and treatment options, with focus on Chlamydia pneumoniae and macrolideviruses
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Huang YJ, Marsland BJ, Bunyavanich S, et al. The microbiome in allergic disease: Current understanding and future opportunities-2017 PRACTALL document of the American Academy of Allergy, Asthma & Immunology and the European Academy of Allergy and Clinical Immunology. J Allergy Clin Immunol. 2017;139(4):1099-1110. doi:10.1016/j.jaci.2017.02.007

Johnston SL. Azithromycin for acute asthma: the AMASE randomized clinical trial. JAMA. 2016;316(17):1711-1713. doi:10.1001/jama.2016.16302