PT  - JOURNAL ARTICLE
AU  - David Hahn
AU  - Michael Grasmick
AU  - Scott Hetzel
TI  - Pragmatic controlled trial of azithromycin for asthma in adults
DP  - 2011 Sep 01
TA  - European Respiratory Journal
PG  - 1877
VI  - 38
IP  - Suppl 55
4099  - http://erj.ersjournals.com/content/38/Suppl_55/1877.short
4100  - http://erj.ersjournals.com/content/38/Suppl_55/1877.full
SO  - Eur Respir J2011 Sep 01; 38
AB  - Background: Macrolides are a novel treatment for asthma.Aims: To investigate macrolide effects after treatment.Methods: Randomized (RAND), placebo-controlled, double-blind parallel group, practice-based trial of azithromycin (AZ), 600 mgm for 3 days, then weekly for 11 weeks or placebo (PLA) with follow up 1 year from randomization. Eligible subjects who declined randomization received open-label (OL) azithromycin.Results: Compared to RAND, OL subjects had more adult-onset asthma, chronic sinusitis, severe persistent asthma and hospitalizations for asthma. Compared to PLA, OL subjects had significant improvements in asthma symptoms and quality of life (QOL) at 1 year (9 months post-treatment). AZ subjects did not have comparable benefits (Table).View this table:Outcomes at 1 year compared to pretreatmentThe proportions of subjects achieving a QOL score change ≥1 unit at 9 months (6 months after finishing treatment) were 22% for PLA, 27% for AZ and 80% for OL (P<.001 compared to PLA). At 1 year the comparable figures were 21%, 36% and 54% (P=.072).Conclusions: OL subjects had severe asthma and persisting benefits, number needed to treat (NNT) = 2 to 4. AZ subjects had milder asthma and did not show benefits, although this study was not powered to detect the NNT = 7 suggested by some results. Azithromycin should be considered as adjunctive therapy for severe asthma unresponsive to guideline treatments. Larger studies are warranted to confirm results in severe asthma and to explore potential benefits in milder asthma.