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Respiratory viral infections such as rhinovirus are an important cause of asthma exacerbations. Some studies suggest atypical infections with Mycoplasma pneumoniae or Chlamydophila pneumoniae also can cause asthma symptoms, but data conflict about whether treating these infections with antibiotics improves outcomes.
In a multicenter U.K. study, 199 adults with asthma exacerbations that required systemic corticosteroids were randomized to azithromycin (500 mg for 3 days) or placebo in addition to usual care. Sputum cultures, serology, or nasal/pharyngeal swabs were positive for bacteria or atypical bacteria in 11% of patients; viral polymerase chain reaction assays were positive in 18% of patients. Asthma symptoms, quality of life, and lung f…