Azithromycin in uncontrolled asthma

Abstract

Asthma is a highly prevalent chronic airway disease affecting more than 300 million people worldwide. Despite treatment with inhaled corticosteroids and long-acting bronchodilators, asthma is uncontrolled in a substantial number of patients who remain symptomatic and are at risk of asthma exacerbations. These asthma attacks are often triggered by viral respiratory infections and might lead to emergency room visits, hospitalisations, and rarely, death; they result in a huge personal and societal burden. 1 Beran D Zar HJ Perrin C Menezes AM Burney P Burden of asthma and chronic obstructive pulmonary disease and access to essential medicines in low-income and middle-income countries. Lancet Respir Med. 2015; 3: 159-170 Summary Full Text Full Text PDF PubMed Scopus (96) Google Scholar Although targeted add-on therapy with monoclonal antibodies such as anti-IgE (omalizumab) and anti-IL5 (mepolizumab and reslizumab) has been shown to be efficacious in specific phenotypes of severe asthma, 2 Castro M Zangrilli J Wechsler ME et al. Reslizumab for inadequately controlled asthma with elevated blood eosinophil counts: results from two multicentre, parallel, double-blind, randomised, placebo-controlled, phase 3 trials. Lancet Respir Med. 2015; 3: 355-366 Summary Full Text Full Text PDF PubMed Scopus (832) Google Scholar , 3 Ortega HG Liu MC Pavord ID et al. Mepolizumab treatment in patients with severe eosinophilic asthma. N Engl J Med. 2014; 371: 1198-1207 Crossref PubMed Scopus (1510) Google Scholar the high costs preclude widespread use in many parts of the world. Therefore, affordable, effective, and safe add-on therapies in patients with poorly controlled asthma are needed. Previous studies have shown a beneficial effect of macrolide antibiotics such as azithromycin on asthma symptoms, but their effect on asthma exacerbations has been inconclusive due to a lack of large long-term trials. 4 Kew KM Undela K Kotortsi I Ferrara G Macrolides for chronic asthma. Cochrane Database Syst Rev. 2015; 9 (CD002997.) PubMed Google Scholar , 5 Reiter J Demirel N Mendy A et al. Macrolides for the long-term management of asthma—a meta-analysis of randomized clinical trials. Allergy. 2013; 68: 1040-1049 Crossref PubMed Scopus (69) Google Scholar Effect of azithromycin on asthma exacerbations and quality of life in adults with persistent uncontrolled asthma (AMAZES): a randomised, double-blind, placebo-controlled trialAdults with persistent symptomatic asthma experience fewer asthma exacerbations and improved quality of life when treated with oral azithromycin for 48 weeks. Azithromycin might be a useful add-on therapy in persistent asthma. Full-Text PDF