Azithromycin counteracts exacerbations in asthma patients

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

In the real-world study presented at CHEST 2021, 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 on the 34 patients included in the observational study, only one did not record a reduction in infections of at least 50% compared to the historical average of 6.44 infections per year.

Overall, the annual average of patients on azithromycin was 1.47 infections per year (P

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

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

  • Find out if real-world use of azithromycin reduced the number of respiratory tract infections – it does
  • To determine if the adverse events seen in clinical studies of the approach manifested in the real world – they did, albeit at a lower rate than seen in clinical trials
  • To determine the reasons for discontinuing azithromycin – 13 patients discontinued use in the study: four due to gastrointestinal adverse events, two due to hearing problems, and seven due to perceived ineffectiveness
  • To determine if long-term use of azithromycin improved lung function – no impact on lung function was observed

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

He explained to MedPage today that azithromycin treatment comes in and out of favor, but the macrolide class of antibiotics are known to reduce inflammation and may be helpful in preventing asthma exacerbations.

For the study, Ajay and colleagues excluded patients with nontuberculous mycobacteria, chronic obstructive pulmonary disease, bronchiectasis, those treated with other long-term antibiotics or with monoclonal antibodies, and those taking nebulized antibiotics. .

All of the patients in the study had asthma and were over 18 (median 58), nine were males and 25 were females. The patients received 250 mg azithromycin tablets three times a week, and the average duration of treatment was approximately 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 current smokers; nine were former smokers and 17 had never smoked.

The limitations of the study, Ajay said, included the small sample size and that there could have been recall bias among patients citing historical infections.

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

Disclosures

Ajay did not disclose any relevant relationship with the industry.

Louie did not disclose any relevant relationship with the industry.

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