Bacterial lysate therapy for the prevention of wheezing episodes and asthma exacerbations: a systematic review and meta-analysis

Abstract

Wheezing and asthma are a growing cause of morbidity in children and adults. Treatment is aimed at prevention of disease exacerbations and preservation of lung function. Respiratory viruses are involved in ∼40–60% of exacerbations. Bacterial lysates prevent recurrent respiratory tract infections and might reduce exacerbations. Moreover, immunomodulatory effects have been observed in human and animal studies. Here we aimed to assess the effects of bacterial lysate therapy on preschool wheezing episodes and asthma exacerbation frequency. We performed a systematic literature review based on the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement and a meta-analysis using Cochrane Review Manager. Out of 2016 retrieved articles, 22 studies were included, of which five provided sufficient data for a meta-analysis.The use of bacterial lysates showed a decrease of both wheezing episodes (mean difference −2.35 (−3.03– −1.67), p<0.001) and asthma exacerbations in children (mean difference −0.90 (−1.23– −0.57), p<0.001). Additionally, antibiotic use was reduced, and the duration of wheezing episodes was also decreased. No data for adults with asthma are currently available. The immunomodulatory effect seems to be dependent on increased T-helper (Th)1-cell activation and Th2-cell suppression.These favourable effects of bacterial lysates indicate that they show promise as add-on therapy in preschool wheezing and childhood asthma.

Bacterial lysate add‐on therapy to reduce exacerbations in severe asthma: A double‐blind placebo‐controlled trial

“…Previous studies in children showed that bacterial lysates were possibly effective in reducing asthma exacerbations 18,20 . Unfortunately, these studies were not all designed or powered to monitor exacerbation frequency.…”

“…Post hoc subgroup analyses, with identical outcomes and statistical plan as described above, were performed for patients being adherent to the study protocol (PP) and PPT2 ( N = 42). Rationale of this PPT2 analysis is that bacterial lysate therapy decreases childhood asthma exacerbations, in asthma that often is allergic in origin 17,18,20 . Patients in the PP analysis were either found to be non‐adherent or expressed no interest/time anymore during the study.…”

“…Additionally, OM‐85 induced pulmonary recruitment of regulatory T cells along with a decrease in bronchial hyper‐reactivity in animal models 15 . Some studies in children suggest shifts in the Th1/Th2 cytokine balance 17,18 …”

“…Also, a recent study showed bacterial lysates to be effective in the improvement of the clinical course of allergic rhinitis 19 . There is some evidence for a decrease in asthma symptoms in school children 17,18,20 . In contrast, studies of adult patients with asthma are scarce.…”

Asma infantil: Efectos inmunomoduladores de los liofilizados bacterianos

“…Según la revisión sistemática y metaanálisis publicados recientemente por Geertje Maria de Boer et al el uso de liofilizados bacterianos mostró una disminución de los episodios de sibilancias y exacerbaciones del asma en niños, redujo el uso de antibióticos y duración de sibilancias y produjo un efecto inmunomodulador beneficioso [1]. Esto se correlaciona con el trabajo publicado por Bartkowiak-Emeryk et al en el cuál se evaluaron los efectos inmunológicos del uso de los liofilizados bacterianos polivalentes en una cohorte de niños con asma alérgico.…”