Relationship Between Pulmonary Tuberculosis And Bronchial Asthma

Relationship Between Pulmonary Tuberculosis And Bronchial Asthma Report of the Committee on Allergy American College of Chest Physicians Several questions have arisen on certain aspects of the relationship between pulmonary tuberculosis and allergic bronchial asthma. A questionnaire was sent to each member of the Committee on Allergy and replies have been received from 18 of the 34 members. A study of these answers and of the chairman's private patient cases reveals the following: 1. Number of Cases One can only approximate the number of patients who have typical allergic bronchial asthma plus active or quiescent pulmonary tuberculosis. A total of 150 cases was reported, including 18 from the chairman's practice. The statistics show that about 1 per cent (one answer said 3 per cent and another 5 per cent) of patients with predominant pulmonary tuberculosis also have bronchial asthma. On the other hand, the majority of the committee feel that less than 1 per cent of patients with predominant bronchial asthma have or have had definite pulmonary tuberculosis. An EI Paso member of the committee, however, reports that about 20 per cent of his asthmatics have an associated tuberculosis. He goes on to say that this 20 per cent were already tuberculous patients in a sanatarium; and that this occurred in the days before streptomycin and other antibiotics. He further states that he now has only the usual 1 per cent approximately of patients with asthma who develop tuberculosis and vice versa of patients with tuberculosis who develop asthma. 2. Age and. Sex Adults predominate in those who have both. The chairman has one child of five who has apparently just recovered from pulmonary tuberculosis and who also has bronchial asthma; another member reports the combination in a child of eight. The rest of the cases, however, range from about 16 to 75. Of the cases reported as to sex, 21 were males, 25 females. 3. Effect of Pulmonary Tuberculosis on the Asthma Accurate answers to this question are rather difficult, but four members stated that tuberculosis seems harmful to the asthma. Eight believed that no harm results. 4. Effect of Bronchial Asthma on Pulmonary Tuberculosis One member felt that the asthma lessened the prognosls as regards the tuberculosis. Five stated that no effect occurred. 5. Use of ACTH and. Steroids ACTH and steroids are now being used in patients who have both bronchial asthma and quiescent or active pulmonary tuberculosis. In such cases, of course, the usual anti-tuberculosis therapy, especially streptomycin, is also employed. The committee members gave some interesting information; of those who replied, four do not use ACTH, while six do. Those who use it are enthusiastic about it, and one of the committee replied that one of his two patients would have died without ACTH and steroids, and that patient's tuberculosis seemed no worse. In the chairman's experience, 589

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ACTH has been used in five cases. In one patient with open tuberculosis, her asthma was so severe that death seemed imminent. Two liters of glucose each with 20 units of ACTH brought prompt and gratifying relief, and her tuberculosis did not seem aggravated. In four other patients with a little less severe status asthmaticus, ACTH was also used, and in each case the asthmatic seizure cleared and the tuberculosis was not increased in three; tubercle bacilli re-appeared in the sputum of the fourth patient. Cortisone and Prednisone According to some members of the committee, these drugs may be somewhat more dangerous, probably because these steroids are used over longer periods. One member of our committee reported that quiescent tuberculosis became active in two of his six cases. Another prefers ACTH to the steroids. In recent literature, other observers have reported activation or re-activation when steroids were employed. The chairman's statistics show that after cortisone was given, tubercle bacilli re-appeared in two cases. In another patient in whom tuberculosis was suspected, the bacilli were first found shortly after cortisone was started; in this patient, no bacilli were found in six previous examinations of the sputum. SUMMARY

The Committee on Allergy of the American College of Chest Physicians reports a statistical relationship between pulmonary tuberculosis and bronchial asthma. The following findings seem apparent after reviewing 150 patients in whom allergic bronchial asthma was associated with active or quiescent pulmonary tuberculosis. 1. About one per cent of patients with predominant pulmonary tuberculosis also have allergic bronchial asthma; an even smaller percentage of those with predominant bronchial asthma have or have had pulmonary tuberculosis. 2. Most patients who have both were adults; there is little distinction as regards

sex.

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3. A minority of the committee feels that bronchial asthma lessens the prognosis as regards co-existing pulmonary tuberculosis, and vice versa. The majority believes that neither condiUon has any important effect on the other. 4. ACTH should be given patients with severe uncontrollable status asthmatiCU8 even though such patients also have active or quiescent pulmonary tuberculosis. A minority of the committee dissents from this view. It is understood that streptomycin, etc., should also be used in such cases. The ACTH may be life-sav1ng. I n most cases the tuberculosis does not seem to be aggravated. 5. Cortisone and prednisone are usually given over longer periods and therefore must be given more cautiously. If severe asthma persists, however, prednisone may well be used, along with anti-tuberculosis therapy. COMMrI"I'EE ON ALLERGY American College of Chest Physicians Leon Unger , Chicago, Illinois Chairman Merle W . Moore, Portland, Qregon Vice Chairman Ethan Allan Brown, Boston, Massachusetts __________________________ Secretary D. L. Anderson, Monroe, Louisiana Harold H . Oberfeld, South Milwaukee, Wisconsin J . S . Blumenthal, Minneapolis, Minnesota H. Rowland Pearsall, seattle, Washington Herbert L. C8.hn, Richland, Washington George Piness, Beverly Hills, California Irving Caplin, Indianapolis, Indiana Edwin P . Preston, Miami, Florida Milton B. Cole, S t. Petersburg, Florida Harry L. Rogers, Philadelphia, Pennsylvania A. G . Corrado, Richland, Washington Irving W. SChiller, Boston, Massachusetts D. Eugene Cowan, Denver, Colorado Nathan E. SUbert, Lynn, Massachusetts Edward Egbert, El Paso, Texas Harry G . Smith, Duarte, California Orville E . Egbert, El Paso, Texas Robert H . Stevens, Phoenix, Arizona Fred Firestone, San Francisco, California Clarence S . Thomas, Nashville, Tennessee Howard L. Hull, Yakima, Washington J . Warrick Thomas, Richmond, Virginia Allan Hurst, Denver, Colorado Albert H . Unger, El Paso, Texas Kellle N. Joseph, Birmingham, Alabama Donald L. Unger, Chicago, Illinois G. A. Koelsche, Rochester, Minnesota George L. Waldbott, Detroit, Michigan Edward Matzger, San Francisco, California Ruth W . Wilson, Beaver, Pennsylvania Lloyd Mayer, Lexington, Kentucky Orval R. Withers, Kansas City, Missouri Fred W. Wittich, Minneapolis, Minnesota