Add-On Azithromycin Associated with Fewer Asthma Exacerbations

By Kelly Young

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

Addition of azithromycin is associated with fewer asthma exacerbations in patients on dual maintenance therapy, according to a Lancet study.

Over 400 adults with symptomatic asthma who were using an inhaled corticosteroid plus a long-acting bronchodilator were randomized to receive oral azithromycin (500 mg) or placebo three times a week for 48 weeks. Patients with abnormal QTc prolongation or hearing impairment were excluded.

The azithromycin group experienced fewer moderate and severe asthma exacerbations than the placebo group (1.07 vs. 1.86 exacerbations per person-year). The treatment group also had better asthma-related quality of life, compared with placebo. However, azithromycin recipients were more likely to report diarrhea (34% vs. 19% of placebo recipients).

Azithromycin-resistant organisms, identified in sputum samples collected after treatment, did not differ significantly between the groups, but the authors note the study was not powered to detect an effect. Lancet commentators conclude: "The effects of long-term therapy with macrolides on community microbial resistance remain a public health concern."