Cure for Asthma? (eBook)

INTRODUCTION

In the late 1980s, while I was conducting a study on a new bacterial cause for bronchitis and pneumonia, I enrolled a 45-year-old woman whom I’ll call Susan. She’d come down with acute bronchitis and had started wheezing for the first time in her life. Her blood tests confirmed that she had an acute (first) infection with Chlamydia pneumoniae, which was the cause of her acute asthmatic bronchitis.1 When I first met Susan, researchers had only just discovered that C. pneumoniae, a so-called “atypical” bacterium, could cause acute bronchitis and community-acquired pneumonia.2 (see Chlamydia Pneumoniae).

Acute asthmatic bronchitis is quite common. Usually, the affected patient’s wheezing goes away as the illness spontaneously subsides.1 Instead of going away, however, Susan’s wheezing got worse, and she began requiring daily asthma medications. Finally, after she had suffered six months of debilitating daily wheezing, chest tightness, and shortness of breath, I referred Susan to one of my partners, a pulmonologist, who performed pulmonary function tests on her. He diagnosed asthma. But despite his treatments, it continued to bother her. By that point, she had also developed persisting high levels of antibodies against C. pneumoniae.

Around the time I referred Susan, I began to notice that almost every wheezing person we had enrolled in our cough study had unusually high levels of C. pneumoniae antibodies. Wheezing was such a reliable symptom, in fact, that I could usually use it to predict when antibody levels would be high. It occurred to me that Susan’s antibody levels had been negative before her illness, but had risen afterwards, and had remained persistently elevated. So I got in touch with her to present a hypothesis: perhaps the Chlamydia infection that had led to her first bout of wheezing had never gone away and was now causing her asthma symptoms.

Chlamydia pneumoniae

What is Chlamydia* pneumoniae?

The first question I often get asked when I mention Chlamydia pneumoniae is: do you mean I have a sexually transmitted disease? The answer is no. Chlamydia pneumoniae causes lung and breathing problems and is not transmitted sexually. The infamous STD is caused by Chlamydia trachomatis, a completely different species. C. trachomatis can also cause diseases such as blindness and arthritis, though it has also been associated with asthma in children.3

C. pneumoniae is similar to C. trachomatis in that it has been associated with a variety of chronic illnesses: not just asthma and other respiratory conditions,4 but also coronary artery disease.5

C. pneumoniae is transmitted in ways similar to the common cold, though not as easily. It’s spread often and to people of all ages. Infection frequently produces no symptoms, but it may cause mild sore throat or sinus problems, or a more severe, prolonged cough, which is generally diagnosed as bronchitis or pneumonia. The infection may persist for a long time. Very recent infection can be diagnosed with antibody testing, but the testing isn’t readily available. Even where it is available, it’s underutilized.

IgM and IgG:

Antibodies are proteins produced by the immune system that latch on to invading bacteria and viruses and help to kill them. A particular kind of antibody called IgM is generally found only during a first infection by any bacteria or virus, and it can thus be used as proof of a very recent infection. Chronic infection, i.e., infection that started more than a few months earlier, is harder to diagnose, because the IgM disappears quickly.

The kinds of antibodies that the body produces next, called IgG, can linger for years after the infection has disappeared. In other words, IgG antibodies could mean that an infection persists, but they could also mean that there was an infection in the past that is no longer present. No wonder, then, that this common infection is hard to diagnose.

Because I happened to see Susan near the beginning of her illness, she still had IgM antibodies against C. pneumoniae. Later, the IgM disappeared, and she then developed high levels of IgG antibodies that lasted for many years, even after she was treated.

One of the unique aspects of Chlamydia is that it must live and reproduce inside cells. Most of us humans worldwide have been infected at one time or another with C. pneumoniae. But Chlamydia tries to stay off of our immune systems’ radar screens, unobtrusively hunkering down. Many of us live in peaceful co-existence with C. pneumoniae, remaining alive and well. But some of us remain alive and unwell. In the process of responding to this uninvited guest, our immune systems can sometimes become irritated and overreact, which can do damage to our tissues and cause inflammatory diseases—like asthma.

* Some scientists refer to these bacteria as “Chlamydophila” instead of “Chlamydia.” But a majority of scientists who study these bugs prefer “Chlamydia,” so that is the term I will use throughout this book.

I suggested that Susan try three weeks of treatment with doxycycline, a tetracycline antibiotic recommended for treating acute C. pneumoniae infections.6 She readily agreed. After that, I became busy with my other patients, and I didn’t spend a lot of time thinking of Susan until about a month later, when she called to ask for a refill of doxycycline. When I asked her why she thought she needed more antibiotics, she told me that her wheezing had gone away after she started on the doxycycline. After she’d finished it, the wheezing had started to come back. Intrigued, I prescribed two more weeks of treatment. Susan completed the treatment—and remained completely asthma-free for the next two years.

Medical scientists argue that clinical stories, including case reports like Susan’s, are the weakest form of scientific evidence and can be misleading. And I agree. But never underestimate the power of a single compelling story to motivate a research career.

Why Did I Write This Book?

The simple answer is because there is a new treatment for asthma that your doctor probably has not discussed with you. It’s my hope that those suffering from asthma symptoms might benefit from this new treatment now.

The complicated answer is because more research is needed before the full future benefits of this new treatment will be completely understood, and I’d like to help move the research forward. In section two, I summarize the scientific evidence behind the treatment to show that there is more than sufficient evidence to support definitive research. And if the research turns out to work as I predict, the results might influence asthma guideline recommendations and make this treatment more widely available.

Because there’s not yet enough evidence-based research on C. pneumoniae’s possible links to asthma, I’ve included several case studies like Susan’s that demonstrate the real, human toll difficult-to-treat asthma can take on quality of life and the remarkable benefits that antibiotic treatment can have on the lives of some asthma sufferers who try it. And since this is a book about stories—not just patients’, but also asthma experts’—I’ll start with my own to explain how I came to discover this novel treatment.

I began medical school at Stanford in the late sixties with the ambition of becoming a medical researcher in the traditional mold. But along the way, I became a family physician instead. What happened?

When I started medical school, the watch-phrase was “clinical relevance!” Researchers were interested in which facts were important for patient care—but the kind of “patient care” research being conducted at large academic medical institutions like Stanford did not necessarily always translate into patient care in the “real world.” In leaving academia to become a family physician, my goal was to identify which medical issues people struggled with in their everyday lives and research those. I didn’t realize at the time how unusual it was to become a primary care doctor who maintained an interest in research.

My career choice had its costs. Because there was virtually no medical research conducted outside of academia, I had no institutional infrastructure and limited funding to support my research. But my career choice has also had its benefits. I have had more intellectual freedom than many professional academic researchers. When I encounter a medical problem in the course of my practice and interactions with patients, I can research it without external pressures or incentives. In contrast, professional academic medical researchers are frequently constrained by available grant funding, and are compelled to “publish or perish.” As a result, they sometimes choose conventional rather than controversial topics. In some cases, academics’ research also suffers from limited access to “real world” patients. And occasionally, researchers may also be swayed by financial ties to funding organizations, though of...