Long-Term Azithromycin for Asthma

As our treatment of patients with asthma improves, we now strive to achieve not just better control, but “remission” (which does not imply a “cure,” but rather near-total symptom control while on therapy). The use of biologics has helped with this goal, but we still have inadequate therapy for so-called “T-helper cell-2 (T_H2)–low asthma,” characterized by low eosinophil counts and exhaled nitric oxide levels and lack of allergic sensitization.* The previously published AMAZES trial showed that 500-mg azithromycin thrice weekly for 1 year lowered asthma exacerbation rates in adults with uncontrolled asthma despite standard inhaled therapy (NEJM JW Gen Med Sep 1 2017 and Lancet 2017 390:659). Now, in a post hoc analysis, the researchers have …