<b><i>Introduction:</i></b> Little is known about the association between bacterial infections and exacerbations of bronchial asthma. <b><i>Objective:</i></b> To elucidate the effect of bacterial infections on bronchial asthma, we examined pharyngeal bacterial colonization, duration of wheezing, and serum levels of cytokines and chemokines during acute exacerbations of asthma in children. <b><i>Methods:</i></b> Potential bacterial pathogens were investigated in pharyngeal samples and viruses obtained from nasal secretions of 111 children who were outpatients and/or in patients with acute exacerbations of asthma (mean/median age: 2.8/2.6, respectively). We also measured serum levels of 27 different cytokines/chemokines. <b><i>Results:</i></b> Pharyngeal bacterial cultures were positive in 110 of 111 children. The 3 major bacterial pathogens were <i>Streptococcus pneumoniae</i> (29.7%),<i> Moraxella catarrhalis</i> (11.7%), and<i> Haemophilus influenzae</i> (10.8%). <i>M. catarrhalis</i> was detected more frequently in patients with pneumonia. Furthermore, patients with <i>S. pneumoniae</i> colonization had significantly shorter wheezing episodes than those without it. In contrast, the duration of wheezing did not differ significantly among cases with other bacteria such as <i>M. catarrhalis</i> and <i>H. influenzae</i>. Furthermore, the length of wheezing episode in patients with <i>S. pneumoniae</i> colonization showed significant inverse correlation with peripheral white blood cell count, neutrophil count, and C-reactive protein, while there was no significant correlation between duration of wheezing and these 3 parameters among patients with <i>M. catarrhalis</i> or <i>H. influenza</i>. Among the 27 cytokines/chemokines, only serum tumor necrosis factor (TNF)-α was significantly lower in patients with <i>S. pneumoniae</i> colonization than in those without it. <b><i>Conclusions:</i></b> These results suggested that pharyngeal <i>S. pneumoniae</i> colonization plays a suppressive role on the pathophysiology during acute exacerbations of asthma.

No abstract

No abstract

<b><i>Introduction:</i></b> Although current guidelines recommend against routine antibiotic prescription for acute exacerbation of bronchial asthma, children with acute exacerbation of asthma receive antibiotic treatment more frequently. In addition, those antibiotics are often prescribed only for exacerbation of asthma without concurrent bacterial infection. <b><i>Objective:</i></b> To clarify the association between antibiotic treatment and bacterial colonization in acute exacerbation of asthma, we investigated whether or not antibiotics affect the clinical condition, laboratory findings, and pharyngeal bacterial colonization in those patients. <b><i>Methods:</i></b> Potential bacterial pathogens were investigated in pharyngeal samples of 111 children with acute exacerbation of asthma (mean/median age: 2.8/2.6 years old, respectively). We collected clinical data, such as the duration of wheezing and antibiotic use, and measured the peripheral white blood cell counts, C-reactive protein, and serum levels of total and allergen-specific IgE. <b><i>Results:</i></b> Antibiotics were used in 50.5% patients with acute asthma exacerbation and included cephalosporin, penicillin, macrolide, and others. Episodes of wheezing were significantly longer in patients with antibiotic treatment than in those without it (6.7 ± 3.6 days vs. 6.0 ± 3.1, <i>p</i> = 0.044). Similarly, episodes of wheezing were significantly longer in moderate exacerbation patients with antibiotics than in those without them. Furthermore, in patients with <i>Streptococcus pneumoniae</i>, antibiotic treatment was associated with an extended duration of wheezing in cases of acute moderate exacerbation (7.0 ± 2.4 days vs. 4.8 ± 4.1, <i>p</i> = 0.043). <b><i>Conclusions:</i></b> These results suggest that antibiotic treatment in acute exacerbation of asthma might lead to longer asthmatic symptoms, specifically in patients with pharyngeal <i>S. pneumoniae</i> colonization.

<b><i>Introduction:</i></b> Allergic sensitization is an important factor in the development, severity, and exacerbation of asthma, which is attributed to type 2 (T2) inflammation. Evidence suggests that respiratory bacterial pathogens (e.g., <i>Streptococcus pneumoniae</i>) exert suppressive effects on airway T2 inflammation. To clarify the role of allergic inflammation in bacterial colonization in asthma based on allergic sensitization, we investigated pharyngeal bacterial colonization, biomarkers (e.g., serum eosinophil cationic protein (ECP) and cytokines/chemokines), and symptoms in the acute exacerbation of childhood asthma. <b><i>Methods:</i></b> Pharyngeal samples were collected from 53 children (mean/median age 2.7/2.5 years). Serum levels of total and allergen-specific IgE against aeroallergens, ECP, and 17 cytokines/chemokines were measured. <b><i>Results:</i></b> Allergic sensitization was recognized in 62.2% patients. <i>S. pneumoniae, Moraxella catarrhalis, Haemophilus influenzae,</i> and other bacteria were detected in 47.1%, 11.3%, 11.3%, and 30.1% of all patients, respectively. Patients with <i>S. pneumoniae</i> had a significantly shorter duration of wheezing than those without (4.7 ± 3.6 vs. 7.1 ± 3.5 days, <i>p</i> = 0.024). In patients with allergic sensitization, patients with <i>S. pneumoniae</i> had a significantly shorter duration of wheezing than those without (4.0 ± 3.6 vs. 7.7 ± 4.0 days, <i>p</i> = 0.003). Serum total IgE was significantly lower in patients with <i>S. pneumoniae</i> than in those without (81.9 [7.8–894] vs. 287 [4.4–1,840] IU/mL, <i>p</i> = 0.014). Serum ECP was significantly higher (33.1 [2–109] vs. 7.8 [3–35] ng/mL, <i>p</i> = 0.042), and IFN-γ was significantly lower (5.6 [4–10] vs. 16.4 [7–28] pg/mL, <i>p</i> = 0.032) in patients with allergic sensitization than those without. <b><i>Discussion/Conclusion:</i></b> Our results suggested that the suppressive effects of <i>S. pneumoniae</i> colonization were observed only in patients with allergic sensitization, wherein serum total IgE, ECP, and IFN-γ may have an important role on acute exacerbation of asthma.

No abstract