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Eur Respir J 2004; 24:710
Copyright ©ERS Journals Ltd 2004

From the authors

E. Kostadima1, S. Tsiodras2, E. Alexopoulos3, A. Kaditis3, I. Mavrou4, N. Georgatou4 and A. Papamichalopoulos4

1 Dept of Critical Care Medicine and 2 Dept of Pediatrics, University of Thassaly School of Medicine and Larissa University Hospital, 3 4th Academic Dept of Internal Medicine, University of Athens School of Medicine, and 4 10th Respiratory Dept, Athens Chest Hospital, Athens, Greece.

In our study 1, an 8-week treatment with clarithromycin was associated with a significant improvement in airway hyperresponsiveness to methacholine in asthmatic patients. As G.P. Currie and D.K.C. Lee correctly point out, this significant change was not accompanied by a clinically important increase in indices of expiratory flow function. We agree that further long-term clinical trials are necessary to identify any beneficial effects of clarithromycin on symptoms of asthma and on markers of airway inflammation.

We chose inhalation of methacholine, a direct stimulus, to detect changes in airway hyperresponsiveness in asthmatics treated with clarithromycin. Provocation with AMP (indirect bronchial challenge) could have also been used. Provocative concentration causing a 20% fall in forced expiratory volume in one second AMP reflects the extent of airway inflammation due to asthma more closely than provocative concentration causing a 20% fall in forced expiratory volume in one second methacholine 2. In addition, as G.P. Currie and D.K.C. Lee appropriately emphasise in their letter, provocation with AMP is more sensitive than provocation with methacholine in detecting changes in airway hyperresponsiveness following anti-inflammatory treatment 3. The fact that we were able to detect improvement in airway hyperresponsiveness using the less sensitive direct bronchial challenge further supports a potentially important role of clarithromycin in the treatment of asthmatic airway disease.

References

  1. Kostadima E, Tsiodras S, Alexopoulos E, et al. Clarithromycin reduces the severity of bronchial hyperresponsiveness in patients with asthma. Eur Respir J 2004;23:714–717.[Abstract/Free Full Text]
  2. Van Den Berge M, Meijer RJ, et al. PC(20) adenosine 5-monophosphate is more closely associated with airway inflammation in asthma than PC(20) methacholine. Am J Respir Crit Care Med 2001;163:1546–1550.[Abstract/Free Full Text]
  3. Wilson AM, Lipworth BJ. Dose-response evaluation of the therapeutic index for inhaled budesonide in patients with mild-to-moderate asthma. Am J Med 2000;108:269–275.[CrossRef][ISI][Medline] [Order article via Infotrieve]




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