The efficacy and safety of azithromycin in asthma: Asystematic review.

Bao‐Ping Tian,Gensheng Zhang,Yesong Wang,Wei Cui,Nanxia Xuan

doi:10.1111/jcmm.13919

Abstract

Azithromycin is a potential therapeutic choice for asthma control, which is a heterogeneous airway inflammatory disease. Because of variable findings, we intend to evaluate the therapeutic effect and safety of azithromycin in asthma. Databases, including PubMed, EMBASE, Cochrane, and CNKI until 31 December 2017, were searched to identify available randomised controlled trials regarding azithromycin treatment for asthma. We identified seven studies involving 1520 cases that met our criteria. The mean difference for lung function (FEV 1, FVC, PEF), symptom assessment (ACQ, AQLQ), airway inflammation, and risk ratios for adverse events were extracted. Chi‐square and I 2 tests were applied to evaluate the heterogeneity among the studies towards each index with a random effect model or a fixed effect model. Pooled analysis shows that azithromycin administration results in no significant improvement in FEV 1 (MD: 0.09, 95% CI −0.10 to 0.29, P = 0.36), PEF (MD: 11.76; 95% CI, −2.86 to 26.38, P = 0.11), total airway inflammatory cells (MD: −0.29; 95% CI, −1.38 to 0.80, P = 0.60), ACQ (MD: 0.05; 95% CI, −0.08 to 0.19, P = 0.44), and AQLQ (MD: 0.12; 95% CI, −0.02 to 0.26, P = 0.10). Moreover, no significant difference was detected in adverse events (Risk ratio 0.99; 95% CI, 0.82‐1.19, P = 0.90). These findings demonstrate no beneficial clinical outcome of azithromycin in asthma control, and we propose that further prospective cohorts are warranted.

Highlights

Bronchial asthma is a heterogeneous disease that is characterised by airway inflammation, mucus over‐secretion, airway hyper‐responsiveness, and eventually, airway wall remodelling.[1]
Some clinical trials have tested the therapeutic effect of azithromycin in asthma, the conclusions were inconsistent
We present the results of a systematic review aimed to provide a summary of the efficacy and safety of administering azithromycin in asthma patients

Summary

Introduction

Bronchial asthma is a heterogeneous disease that is characterised by airway inflammation, mucus over‐secretion, airway hyper‐responsiveness, and eventually, airway wall remodelling.[1] Asthma affects 5%‐16% and up to 334 million people worldwide and result in substantial medical expenditures.[2,3] Currently, daily inhaled corticosteroids combined with long‐acting β2 agonists are the first‐line strategy of asthma treatment. Other drugs, including leukotriene‐receptor antagonists, theophylline, long‐acting anti‐cholinergics, and even oral corticosteroids, are added for those asthma patients who were not well controlled.[4] Besides antibacterial effects, macrolides such as azithromycin are reported to have immunomodulatory and anti‐ inflammatory effects in airway inflammatory disease, including cystic fibrosis, bronchiectasis, exacerbation of chronic obstructive pulmonary disease, and severe asthma.[5,6,7,8] some clinical trials have tested the therapeutic effect of azithromycin in asthma, the conclusions were inconsistent. We present the results of a systematic review aimed to provide a summary of the efficacy and safety of administering azithromycin in asthma patients

Methods

Findings

Discussion

Conclusion