The asthma-antibiotic connection

Do Antibiotics Now Mean Asthma Later?
by Carol Potera

Asthma affects 1 in 8 school-aged children in industrialized countries,
making it the most common chronic illness in this group. Now a
meta-analysis of child asthma studies led by pharmaceutical scientist
Fawziah Marra of the University of British Columbia shows that children
diagnosed with asthma were twice as likely as nonasthmatics to have
received antibiotics before age 1. The more courses of antibiotics a child
received in the first year of life, the higher the risk for asthma.

The meta-analysis, reported in the March 2006 issue of Chest, examined the
link between antibiotic exposure in babies and subsequent development of
asthma, as well as the dose-response relationship. Marra's team analyzed
four prospective studies and four retrospective studies conducted between
1999 and 2004. Each study involved between 263 and 21,120 children,
including cases who had been diagnosed with asthma between the ages of 1
and 18 years. The number of antibiotic courses taken ranged from one to
seven, and averaged three.

Pooling the data from all eight studies revealed a twofold risk of
developing asthma with at least one course of antibiotics. Each additional
course raised asthma risk 1.16 times. Information about the antibiotics
prescribed could not be obtained from the studies.

The findings support the "hygiene hypothesis," which proposes that an
immune system that doesn't get enough practice killing germs (due to
either an excessively clean environment or overuse of antibiotics) will
become overly sensitized and overreact to normally harmless environmental
agents such as pollen and dust.

Marra and her colleagues recently launched a community education campaign
in British Columbia called "Do Bugs Need Drugs?" The program uses media
ads, classroom visits, and educational materials to teach health
professionals and the general public about the overuse of antibiotics. The
campaign emphasizes the difference between bacterial and viral infections,
useful preventive measures such as hand washing, and the need to use
antibiotics wisely. "In children, antibiotics are commonly used to treat
ear infections, upper respiratory tract infections, and bronchitis," says
Marra, even though many such infections are viral and don't respond to
antibiotics. Some parents may refuse to leave a doctor's office without a
prescription.

The information gained from the meta-analysis is valuable for physicians
who are striving to cut back on prescribing antibiotics, says W. Michael
Alberts, president of the American College of Chest Physicians: "It can
help to convince parents of young children to hold off on giving
antibiotics unless absolutely necessary."

From Environmental Health Perspectives Vol 114(6); June 2006

Comment
There are different ways to look at this study, depending on what philosophy you apply to it.

Anthroprosophical medicine would suggest that with each infection a young child 'incarnates' into it's body more and observes after each fever a child may appear a little older/have a developmental spurt. The theory would suggest that if we stop fevers, then perhaps we interfere with both the development of the immune system and perhaps the child as a whole.

Other alternative health commentators may suggest it is the role of antibiotics in disrupting gut flora that may have a direct effect on the immune system.

I am not sure if it is one single factor.

Further area of study needs to look at the children who didn't have antibiotics. Did they have as many of the same types of illness, but were treated without pharmaceutical intervention, or were these children essentially healthy?

Naturopathically, children who have more allergies (eg eczema and hayfever) or ear, nose and throat recurrent illnesses appear to have a higher risk of developing asthma, but whether that is constitutional or acquired - we are yet to find out.