Can a bacterial infection cause chronic asthma?
The National Institutes of Health have awarded $7.5 million to National Jewish Medical and Research Center to find the answer.
The study, which could dramatically alter treatment of the ailment afflicting 20 million Americans, all started with one woman’s crippling asthma and the discovery of bacteria in her lungs.
Dr. Richard Martin, the study’s lead investigator, said he and researchers at seven other centers hope to enroll 126 chronic asthma patients from around the country.
The patients will be tested to see whether they have bacteria in their lungs. Those who do will get either antibiotics or a placebo.
The goal is to find out how antibiotic treatment affects asthma symptoms.
Martin, who is chairman of National Jewish’s Department of Medicine, said he also hopes to perfect a new method for identifying lung bacteria.
The current method, a bronchoscopy, requires putting a tube into the lungs – an procedure uncomfortable enough that patients must be sedated.
The study’s two goals could help physicians decide whether to prescribe antibiotics for asthma patients, Martin said.
This multimillion-dollar project, however, might never have happened if it weren’t for Diane Cushman-Neal.
A decade ago, Cushman-Neal was getting state-of-the-art treatments, but asthma was slowly taking her life.
“I was 21, and my friends were all starting careers, having a good time, and I was in the hospital,” she said. “I needed assistance to walk to the bathroom.”
Her doctors in San Diego laid out her options: a lung transplant; an experimental treatment with chemotherapy; or giving up.
Reversal of fortune
After being put on antibiotics for her debilitating asthma, a patient rebounded – and did a triathlon last year.
“My doctor said, ‘We’re running out of options, but I really think National Jewish is your best choice,”‘ Cushman-Neal said.
At National Jewish, Martin took a biopsy of her lungs.
As the lab technician looked at Cushman-Neal’s sample amplified by an electron microscope, he summoned Martin.
“He said, ‘Look at all these squiggly things,”‘ Martin said.
The squiggly things were the same bacteria that, in larger amounts, cause pneumonia.
Martin put Cushman-Neal on antibiotics, which she says changed her life.
In 2005, Cushman-Neal, who now lives in Denver, did a sprint-distance triathlon in San Diego, and she has run the Bolder Boulder 10-kilometer race.
She also got married and adopted two children.
Since Cushman-Neal’s treatment, Martin and others have published studies showing that a little over half of those suffering from asthma have bacteria in their lungs.
The bacteria are common, and not everyone who has contact with them gets asthma.
“I think you have to have a genetic predisposition,” Martin said.
In addition, he suspects an interaction between allergens and the bacteria.
“It’s a new area, so we don’t have full understanding of the exact role” of how allergens and bacteria work together to trigger asthma, Martin said.
Initial studies in mice indicate that being infected with bacteria first, and then exposed to allergens, tends to lessen the body’s immune response – making asthma less likely.
In the opposite order – allergen first, bacteria second – the body “ramps up the response” to the allergen. That can lead to allergies, Martin said, and the theory goes, to asthma.
The reaction also may help explain why asthma rates are rising more rapidly in urban areas than rural ones and supports the so-called hygiene hypothesis.
The hygiene hypothesis holds that early contact with some germs bolsters the maturing immune system against allergic conditions.
“It’s a very intriguing idea, and it goes along with the hygiene hypothesis,” Martin said.
Martin is not sure whether researchers might one day determine that treating bacterial infections immediately when they occur could prevent asthma altogether.
Those interested in learning more about the study may call 303-398-1443.
Staff writer Karen Augé can be reached at 303-820-1733 or kauge@denverpost.com.
