Oh, forgot. Of course the B*  people will disagree.

.........

Joy,

A Medline search for related artiicles produced the following.

1. Kraft M, Cassell GH, Pak J, Martin RJ. (the artiicle hunted up by
A. Roberts)
    Mycoplasma pneumoniae and Chlamydia pneumoniae in asthma: effect of
clarithromycin.
Chest. 2002 Jun;121(6):1782-8.

2:     Martin RJ, Kraft M, Chu HW, Berns EA, Cassell GH.    
    A link between chronic asthma and chronic infection.
J Allergy Clin Immunol. 2001 Apr;107(4):595-601.

3:     Kraft M, Cassell GH, Henson JE, Watson H, Williamson J, Marmion
BP, Gaydos CA, Martin RJ.
    Detection of Mycoplasma pneumoniae in the airways of adults with
chronic asthma.
Am J Respir Crit Care Med. 1998 Sep;158(3):998-1001. .

The full text of 1 and 3 can be downloaded by anybody via Medline
without any sort of subscriptioon.

As for Colin, it seems at times that he is too much interested in
anti-quack activities.  Discussion at a different level might mean
that crudities would be ignored automatically.  But then the group
might be of less interest for the average asthmatic.  Richard Friedel

him. It

now onboard.

I wouldn't say that even most are on board - much less
"everyone."

I've been meaning to right a faq about this for some time
and this seems like a good place to try a first draft so
I'll give it a go befre going off to bed. .

1) Is asthma caused by an infection?

Maybe for some people. Chances are that asthma is not one
disease and that it has several different causes at play to
varying degrees to different people and even the same people
over time. There is some evidence linking asthma to
infections in some people but the issue is not proved yet.
When the populations are highly selected for people to be at
risk (adult onset after a serious infection) the percentage
seems to be about 50%. In studies with less specific
selection it has been in the 10-30% range. My personal
prediction, based on experience with similar circumstances
much more than data, is that when they start to screen large
populations of asthmatics the percentage will be less than
that, possibly even zero (but I also think it will be
something above zero).

2) Can treating the infection cure the asthma?

Probably not for most asthmatics but maybe for a few. As I
said above I find it doubtful that an infectious link will
be found in the majority of asthmatics. Even then, for many
it will probably turn out to be one of several factors and
so eradicating the infection will only provide a partial
cure. Also, there is the possibility that even if the
infection is the original trigger that eradicating it will
not help with the symptoms as they may be due to some other
change, like an immune reaction, that will not so easily go
away. And again, this whole theory shows some promise but it
is not yet proved. Others with similar early support and
biologic plausibilty have failed to pan out.

3) If I decide to try antibiotics how should it be done?

Not at all determined The proposed organisms would be
expected to be killed by several several different
antibiotics and several have been tried. Azithromycin seems
to be the most studied but there may be cheaper alternatives
that one would guess should work (and some have some samll
studies). It does seem likely that conventional doses will
be effective but that the course will need to be prolonged -
at least 6 weeks, probably more like 12, and possibly even
longer.

4) Why not try?

There are several reasons:

a - Cost. The courses of antibiotics being studied now would
cost at least hundreds, and possibly thousands of dollars.
It may be hard to get insurance carriers to pay for this.
This is especially an issue if the money used to buy the
antibiotics is taken from money used to do things known to
improve health or lifestyle.

b - Side effects. Diarrhea, allergy, and GI upset, and other
gut infections would be the most common ones but other rare
ones include sever skin reactions, agranulocytosis (low
white cell counts), and other severe reactions. The class of
antibiotics usually used also has special concerns for
pregnant women.

c - Diagnostic uncertainty. Asthma naturally waxes and wanes
in severity. If you are treated for a prolonged course the
chances are that at some point the asthma will get better
through chance alone and you will be tempted to attribute it
to the antibiotics. Then when it later gets worse again the
temptation will be to go back on the antibiotics again or to
prolong their course. This could end up with you in a cycle
where you are reluctant to ever get off of them despite the
fact that they are probably doing nothing for you.

d - Therapeuitc uncertainty. Right now, even if you assume
that the asthma is from an infection, no one knows how to
treat it. Researchers are still looking at differnet drugs,
dosages, and durations of treatment. You may be taking the
risks with little chance of success or taking more risk than
is needed. The answers may be more clear in the another year
or two.

e - Why rock the boat? If your asthma is under control why
do anything to change that?  (See bolow for more on this)

5) Should I give it a try?

For most asthmatics I would say no. The "conventional" meds
have been proved to work,  prevent long term lung damage,
and are safe when used in "normal" doses. If you have a
classic history for asthma such as onset at a young age, a
family history of asthma or allergies, or other allergic
conditions (rhinitis, eczema, atopic dermatitis, food
intolerances, etc.) it is unlikely that your asthma is from
an infection. If your asthma is well controlled on moderate
doses of meds then it just doesn't seem worth the risks to
me.

If your asthma is so difficult to control that you have to
take high doses of inhaled steroids or frequent bursts of
oral prednisone, and especially if it is still poorly
conrolled despite these, then the risks from "conventional"
medications is substantially higher and may warrant
considering it. Also, if you lack the classic history and
your symptoms started with a respiratory infection that just
never seemed to completely go away, especially as an adult,
then you may be more likely to benefit. If you decide to do
it I would make a pitch to try to do so in the a research
study so that your experiences can help to clarify some of
these issues.