REAL-WORLD STUDY ON THE USE OF AZITHROMYCIN IN ASTHMA: EXPERIENCE FROM A DISTRICT TEACHING HOSPITAL

Abstract

TOPIC: Allergy and Airway TYPE: Original Investigations PURPOSE: Asthma affects approximately 300 million people world-wide with the global burden of disease estimated to be 15 million disability-adjusted life-years. Azithromycin exhibits anti-inflammatory effects in addition to antibiotic properties. The British Thoracic Society guidelines recommends long-term macrolides use in adult asthmatics to reduce exacerbation rate. Azithromycin has been associated with side effects like prolonged QTc, ventricular arrhythmias, hearing impairment and diarrhoea. Real world studies are important for clinical decision making. This study aimed to determine if there is an improvement in the number exacerbations in asthmatic patients on long-term azithromycin in addition to other aspects of prescription METHODS: An observational study looking at 34 asthmatic patients on azithromycin was done. The patient data sets were anonymised and analysed on an Excel 2010 Spread sheet. Asthmatic patients aged 18 and over were included. This study excluded patients with non-tuberculosis mycobacterium, overlap conditions such as COPD and bronchiectasis, and patients on nebulised antibiotics or monoclonal antibodies.Data collected included: age, sex, respiratory diagnosis, co-morbidities, and immune status, number of infections and hospitalisations prior to and after staring azithromycin, lung function, corrected QT intervals, hearing issues, liver function test and gastrointestinal symptoms. RESULTS: 34 asthmatic patients (9 male, 25 female) with a median age of 58 (Range: 23-81) years were commenced on prophylactic azithromycin at the dose of 250mg Three times a week. The average BMI was 31.66 (S.D. 7.83). There were 8 smokers, 9 ex-smokers and 17 non-smokers. 7 patients were immunosuppressed. The dose prescribed was 250 mg three times a week. Mean duration was 39.83 (S.D. 24.04). Treatment was stopped in 13 patients: 7/13 for ineffectiveness, 4/13 for side effects (gastrointestinal problems 2/13 and hearing issues in 2/13), and 2/13 for other reasons not documented. Approximately 5.8 % hearing impairment exclusively due to azithromycin. Additionally, 2/34 patients (1 male, 1 female) had prolonged QTc before starting and 5/34 patients (3 female, 2 male) had prolonged QTc after starting azithromycin. No statistical significance (p>0.05) in the FEV1: FVC ratio before and after starting azithromycin. The average number of infections in the pre-treatment group was 6.44 (S.D. 2.80) versus 1.52 (S.D. 2.20) in the post azithromycin phase. The reduction in the number of infections and hospitalisations over the 12 months following treatment was significant with p<0.001 and p<0.034, respectively. 12/34 patients experienced a 100% reduction in the number of infections. Information on number of infections pre and post treatment were based on patients recalling and may pose a recall bias CONCLUSIONS: Long-term prophylactic azithromycin has been shown to correlate with a significant reduction the number of infections and hospitalisations in asthmatic patients. Our study did not show any lung function improvements with azithromycin use and the adverse effect hearing loss similar to previous studies of 5% CLINICAL IMPLICATIONS: Azithromycin is a safe and effective prophylactic drug in reducing exacerbations in this cohort of asthma patients our real world experience is in keeping with studies done so far DISCLOSURES: No relevant relationships by Hanan Ajay, source=Web Response No relevant relationships by Tanya Gordon, source=Web Response No relevant relationships by Nargis Khatoon, source=Web Response No relevant relationships by Aravind Ponnuswamy, source=Web Response