Long-term azithromycin increases lumen radius, area in severe persistent asthma
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Long-term azithromycin treatment increased lumen radius and lumen area in patients with severe persistent asthma, but did not affect bronchial wall thickness, according to new data published in Respiratory Medicine.
“Although the effect of corticosteroids on airway remodeling has been widely investigated, little attention has been paid to other asthma medications. Recent studies revealed that azithromycin could ameliorate airway remodeling in animal models of asthma,” Mohammadamin Sadeghdoust, MD, MPH, of the department of internal medicine at Mashhad Medical Sciences Branch, Islamic Azad University, and the Health Policy Research Center at the Institute of Health at Shiraz University of Medical Sciences, Iran, and colleagues wrote. “In addition, the Global Initiative for Asthma has recently recommended long-term use of low-dose azithromycin in patients with severe asthma. However, to our best knowledge, no publications could be found about azithromycin’s effect on airway remodeling in human subjects.”
The double-blind, placebo-controlled, randomized clinical trial included 78 adults with severe persistent asthma. All patients were randomly assigned to azithromycin 250 mg twice per day 3 days per week (n = 25), prednisolone 5 mg twice per day (n = 27) or placebo (n = 26) for 8 months in addition to standard therapy.
The primary outcome was improvement in right upper-lobe apical segmental bronchus wall thickness. Secondary outcomes included cough severity, dyspnea severity, asthma control test score, asthma exacerbation rate, pulmonary function tests and fractional exhaled nitric oxide (FeNO).
The researchers reported no significant change in bronchial wall thickness percentage in any of the treatment groups.
However, researchers observed significant increases in the inner lumen radius (1.23 mm/m2 to 1.25 mm/m2) and lumen area (4.4 mm/m2 to 4.8 mm/m2) among patients assigned azithromycin (P < .05 for both). The prednisolone group demonstrated similar significant increases in the inner lumen radius (1.29 mm/m2 to 1.34 mm/m2) and lumen area (5.46 mm/m2 to 5.91 mm/m2; P < .05 for both).
In addition, dyspnea severity, asthma control test score, FENO2 and FEV1, forced expiratory flow and ratio of FEV1/FVC were significantly improved in the azithromycin group (P < .05 for all). In those assigned azithromycin, cough severity and asthma exacerbation rate did not significantly change over 8 months of azithromycin treatment.
“Overall, these findings suggest that azithromycin is a potentially useful add-on treatment option in patients with severe persistent asthma, but it has no effect on airway wall thickness,” the researchers wrote.