Conclusion Chlamydia pneumoniae Chronic Nonspecific Lung Disease Cnsld And The Dutch Hypothesis

According to Vermeire et al.,(9) the CIBA Symposium proposed chronic nonspecific lung disease (CNSLD) in 1959 as an umbrella term for chronic i bronchitis, asthma, emphysema and irreversible or persistent obstructive lung disease. In 1961 Orie(23) proposed the "Dutch Hypothesis" which stated that CNSLD represented different expressions of a single disease entity characterized by an hereditary predisposition to develop allergy and bronchial hyper reactivity in response to environmental factors. Prior to the discovery of the Cpn-asthma association, the pros and cons of the "Dutch Hypothesis" were fully debated without the hypothesis being proven or disproven.(9,10) It should be obvious to the reader of this review that the discovery of Cpn as a potential factor in asthma and COPD casts new light on the importance of examining the concept of CNSLD as a pathophysiologic entity.

It is now well established that acute Cpn infection can cause acute bronchitis and pneumonia(149,150) and additional evidence presented herein suggests that lower respiratory tract illnesses caused by acute Cpn infection can develop into asthma and chronic bronchitis.(8,151) Chronic Cpn infection has also been associated with a wide variety of chronic upper-airway illnesses(152,l53) as well as with the spectrum of acute and chronic lower-airway conditions including acute bronchitis,(154) asthma and COPD.(81) Taken together, these data suggest a role for Cpn in the entire spectrum of respiratory illnesses embracing the natural history of CNSLD.(19,20,155) Just as early identification and treatment of genital chlamydial infection of women is required to prevent the occurrence of pelvic inflammatory disease and tubal infertility, and timely treatment of eye infection in children is required to prevent blinding trachoma, early identification and treatment of Cpn infection in chronic airways disease will be important to prevent the development of chronic sequelae, if Cpn is confirmed as a treatable cause for even a subset of CNSLD.

Acknowledgments. I would like to thank Mary Beth Plane for a critical review of a previous draft of this chapter.

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