Adult acute asthmatic bronchitis is a term which, like the early Homeric epics, appears to have had a long and well-recognized verbal tradition in the primary care community but is not yet written down, in the sense that I have been unable to find a textbook of pulmonology in which adult acute asthmatic bronchitis is defined or acknowledged to exist.
In this regard a recent study isolated C pneumoniae in 16 (26%) of 62 acute bronchitis patients, many of whom had asthmatic bronchitis.(30) When assessed 6 weeks after treatment, all but 2 patients were cured (13 patients) or improved (1 patient) after receiving azithromycin, 1500 mg over 5 days.
Most physicians administer antibiotics to patients with acute bronchitis despite lack of evidence of effectiveness from controlled trials.(29) Preliminary results support the use of prolonged courses of antichlamydial antimicrobial therapy in some cases of adult-onset asthma.(23)(27)(33) Should we prescribe antibiotics for adult-onset asthmatics who are C pneumoniae seroreactive or, when serologic results are unavailable, for those with a history of previous episodes of acute asthmatic bronchitis? There are as yet no controlled studies to help answer this question.
Thirty (22.9%) patients were classified with acute asthmatic bronchitis, and 89 (67.9%) had nonwheezing illness.
In a previous prospective study designed to assess the role of acute C pneumoniae infection in bronchitis and atypical pneumonia, we found post hoc associations of C pneumoniae seroreactivity with wheezing, asthmatic bronchitis, and adult-onset asthma.(9) We now report results of culture and serology for M pneumoniae and C pneumoniae in a series of patients with asthma confirmed by pulmonary function testing, studied during a M pneumoniae epidemic.