Adding azithromycin to standard care improves asthma control, exacerbations in children

The addition of oral azithromycin to standard treatment improved asthma control and reduced exacerbations compared with standard treatment alone among children with poorly controlled asthma, according to data published in Chest.

“In adults, use of azithromycin had shown to reduce the number of exacerbations and improve spirometry parameters and recommended from Global Initiative for Asthma and British Thoracic Society,” Jagat Jeevan Ghimire, MD, from the division of pediatric pulmonology and intensive care in the department of pediatrics at the All India Institute of Medical Sciences, New Delhi, and colleagues wrote. “Good quality data are lacking in childhood asthma.”

The researchers conducted an open-label, randomized controlled trial that enrolled 120 children (mean age, 9.9 years; 74% boys) aged 5 to 15 years with poorly controlled asthma defined by Asthma Control Test (ACT) and Childhood Asthma Control Test (CACT). All children were randomly assigned to azithromycin 10 mg/kg (n = 60) three times a week for 3 months in conjunction with standard treatment or standard treatment alone (n = 60). Standard treatment included inhaled corticosteroid with or without LABA.

The primary outcome was the ACT and CACT score at 3 months. Secondary outcomes included asthma control measured by Global Initiative for Asthma (GINA) guidelines, number of asthma exacerbations, spirometry parameter change, fractional exhaled nitric oxide change, throat swab positivity and adverse events.

At 3 months, mean ACT and CACT score was higher in the azithromycin group compared with the standard treatment group (21.71 vs. 18.33; P < .001).

A higher proportion of children had well-controlled asthma defined by GINA guidelines in the azithromycin group compared with the standard treatment group (41 vs. 10; P < .001).

Children assigned azithromycin also had a lower median number of exacerbations that required an ED visit and steroid use compared with the control group (0 vs. 1; P < .001).

Researchers observed no differences in fractional exhaled nitric oxide, spirometry parameters, throat swab positivity and adverse events between the two groups.

According to the researchers, the benefits of azithromycin were similar in children with eosinophilic asthma compared with non-eosinophilic asthma and among those aged 5 to 11 years and at least 12 years.

“Management of poorly controlled asthma in children is challenging. There is emphasis on personalized asthma management that includes biologicals also, but it is limited by high cost and unavailability,” the researchers wrote. “Hence, a cheaper, safe, effective and readily available drug like azithromycin can help in management of the children with poorly controlled asthma.”