Azithromycin thwarts exacerbations in asthma patients

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Exacerbations were cleared in about a third of adult asthma patients treated prophylactically with the macrolide azithromycin, one researcher reported.

Presented in the real-world study at CHEST 2021, of the American College of Chest Physicians’ annual meeting held online, Hanan Ajay, a fifth year medical student at the University of Liverpool in England, said that of the 34 patients enrolled in the observational study, only one did not experience a reduction in infections by at least one 50% versus the historical average of 6.44 infections per year.

Overall, the annual average for patients taking azithromycin was 1.47 infections per year (P.

The research team set out to test how that British Thoracic Society recommendations for the long-term use of macrolides to reduce the rate of exacerbations in adults with asthma that occurs in the real world. “The macrolide of choice in the UK is azithromycin,” noted Ajay.

The study had four goals and the results were as follows:

  • Determine if using azithromycin in the real world has reduced the number of respiratory infections – it has
  • Determine if the adverse events observed in clinical trials of the approach manifested in the real world – they did, albeit at a lower rate than observed in clinical trials
  • Determine reasons for stopping azithromycin – 13 patients discontinued use in the study: four due to gastrointestinal side effects, two due to hearing problems, and seven due to perceived ineffectiveness
  • Determine if long-term use of azithromycin improves lung function – no effect on lung function has been observed

When asked about his perspective, Steven Louie, MD, of Florida Allergy & Asthma Associates at Atlantis, said, “I have used azithromycin as a prophylactic treatment on my patients from time to time, but it is not the standard of treatment.”

He declared MedPage today Azithromycin treatment is becoming increasingly popular, but the macrolide class of antibiotics are known to reduce inflammation and can be helpful in preventing asthma exacerbations.

For the study, Ajay and colleagues excluded patients with non-tuberculosis mycobacteria, chronic obstructive pulmonary disease, bronchiectasis, patients treated with other long-term antibiotics or with monoclonal antibodies, and patients who were taking aerosolized antibiotics.

All patients in the study had asthma and were over 18 years old (median 58), nine were men and 25 were women. Patients received azithromycin 250 mg tablets three times a week and the mean duration of treatment was about 40 months. Seven of the patients included in the study were considered to be immunocompromised. The average body mass index was 31.7. Eight of the patients in the study were smokers; nine were ex-smokers and 17 were never-smokers.

Study limitations, Ajay said, included the small sample size and that patients may have had recall errors in reporting historical infections.

  • Ed Susman is a freelance medical writer based in Fort Pierce, Florida, USA.

Disclosure

Ajay did not disclose any relevant relationships with the industry.

Louie did not disclose any relevant industry relationships.

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