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Macrolide therapy in asthma: limited treatment, long-term improvement

D. L. Hahn
European Respiratory Journal 2009 33: 1239; DOI: 10.1183/09031936.00000209
D. L. Hahn
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To the Editors:

As part of their interesting review of long-term macrolide therapy in chronic inflammatory airway diseases, Crosbie and Woodhead 1 cite eight randomised double-blind placebo-controlled trials of macrolide therapy in asthma. Most were small, and all were short-term (none >12 weeks). Some positive effects were noted; mechanisms proffered included both anti-inflammatory and antimicrobial (including against Chlamydia pneumoniae).

I would like to draw the authors’ attention to another randomised double-blind placebo-controlled trial of azithromycin in adults with stable persistent asthma 2 that was not included in their review. Azithromycin was chosen for this study based on a before–after study 3 that found significant clinical and spirometric responses in azithromycin-treated adults with asthma and evidence of C. pneumoniae infections. Azithromycin’s extended intracellular half-life permits convenient weekly dosing as antichlamydial therapy 4. The trial 2 employed a total of six weekly azithromycin doses and assessed outcomes 3 months after treatment completion.

Positive findings were: 1) a significant improvement in overall asthma symptoms at treatment completion that persisted unabated for 3 months despite withdrawal of azithromycin; and 2) baseline (pre-treatment) anti-C. pneumoniae immunoglobulin A antibodies significantly predicted asthma symptoms at follow-up. The trial was underpowered to assess the interaction between antibody status and treatment outcome; nevertheless, symptom improvement attributable to azithromycin was twice as great in antibody-positive compared with antibody-negative subjects.

Overall, the results lend further evidence in support of performing larger longer-term trials to assess the clinical utility of azithromycin in asthma and to parse the underlying mechanism(s). A somewhat larger but still small effectiveness trial of a total of 12 weekly azithromycin doses with follow-up at 1 yr is currently under way (NCT00266851; www.ClinicalTrials.gov).

Statement of interest

None declared.

    • © ERS Journals Ltd

    References

    1. ↵
      Crosbie PAJ, Woodhead MA. Long-term macrolide therapy in chronic inflammatory airway diseases. Eur Respir J 2009;33:171–181.
      OpenUrlAbstract/FREE Full Text
    2. ↵
      Hahn DL, Plane MB, Mahdi OS, Byrne GI. Secondary outcomes of a pilot randomized trial of azithromycin treatment for asthma. PLoS Clin Trials 2006;2:e11
      OpenUrl
    3. ↵
      Hahn DL. Treatment of Chlamydia pneumoniae infection in adult asthma: a before–after trial. J Fam Pract 1995;41:345–351.
      OpenUrlPubMedWeb of Science
    4. ↵
      Martin DH, Mroczkowski TF, Dalu ZA, et al. A controlled trial of a single dose of azithromycin for the treatment of chlamydial urethritis and cervicitis. N Engl J Med 1992;327:921–925.
      OpenUrlPubMedWeb of Science
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    Macrolide therapy in asthma: limited treatment, long-term improvement
    D. L. Hahn
    European Respiratory Journal May 2009, 33 (5) 1239; DOI: 10.1183/09031936.00000209

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    Macrolide therapy in asthma: limited treatment, long-term improvement
    D. L. Hahn
    European Respiratory Journal May 2009, 33 (5) 1239; DOI: 10.1183/09031936.00000209
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