Incident asthma and Mycoplasma pneumoniae: A nationwide cohort study - 14/11/15

Doi : 10.1016/j.jaci.2015.09.032

Jun-Jun Yeh, MD ^a,^b,^c, Yu-Chiao Wang, MSc ^d,^e, Wu-Huei Hsu, MD ^e, Chia-Hung Kao, MD ^f,^g,^⁎
^a Department of Chest Medicine and Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
^b Chia Nan University of Pharmacy and Science, Tainan, Taiwan
^c Meiho University, Pingtung, Taiwan
^d Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
^e School of Medicine, China Medical University Hospital, Taichung, Taiwan
^f Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University Hospital, Taichung, Taiwan
^g Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan

^∗Corresponding author: Chia-Hung Kao, MD, Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Rd, Taichung City 404, Taiwan.

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Abstract

Background

Previous studies investigating the relationship between Mycoplasma pneumoniae and incident asthma in the general population have been inconclusive.

Objective

We conducted a nationwide cohort study to clarify this relationship.

Methods

Using the National Health Insurance Research Database of Taiwan, we identified 1591 patients with M pneumoniae infection (International Classification of Diseases, Ninth Revision, Clinical Modification code 4830) given diagnoses between 2000 and 2008. We then frequency matched 6364 patients without M pneumoniae infection from the general population according to age, sex, and index year. Cox proportional hazards regression analysis was performed to determine the adjusted hazard ratio (aHR) of the occurrence of asthma in the M pneumoniae cohort compared with that in the non–M pneumoniae cohort.

Results

Regardless of comorbidities and the use of antibiotic or steroid therapies, patients with M pneumonia infection had a higher risk of incident asthma than those without it. The aHR of asthma was 3.35 (95% CI, 2.71-4.15) for the M pneumoniae cohort, with a significantly higher risk when patients were stratified by age, sex, follow-up time, and comorbidities, including allergic rhinitis, atopic dermatitis, or allergic conjunctivitis. Patients with M pneumoniae infection had a higher risk of having early-onset (age, <12 years; aHR, 2.87) and late-onset (age, ≥12 years; aHR, 3.95) asthma. The aHR was also higher within the less than 2-year follow-up in the M pneumoniae cohort (aHR, 4.41; 95% CI, 3.40-5.74) than in the cohort without the infection.

Conclusion

This study found that incident cases of early-onset and late-onset asthma are closely related to M pneumoniae infection, even in nonatopic patients.

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Key words : Mycoplasma pneumoniae, asthma, antibiotic, steroid, cohort study

Abbreviations used : aHR, AC, AD, AR, IRR, LHID

Plan

Methods

Data source

Study population

Outcome and potential factor measurement

Supported in part by the Taiwan Ministry of Health and Welfare Clinical Trial and the Research Center of Excellence (MOHW104-TDU-B-212-113002); the China Medical University Hospital, Academia Sinica Taiwan Biobank, Stroke Biosignature Project (BM104010092); the NRPB Stroke Clinical Trial Consortium (MOST 103-2325-B-039-006); the Tseng-Lien Lin Foundation, Taichung, Taiwan; the Taiwan Brain Disease Foundation, Taipei, Taiwan; the Katsuzo and Kiyo Aoshima Memorial Funds, Japan; and the CMU under the Aim for Top University Plan of the Ministry of Education, Taiwan.

Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest.