Macrolides Improve Asthma Control and Reduce Severe Exacerbations, finds study

A new study published in The Journal of Allergy and Clinical Immunology showed that macrolide treatment probably improves asthma control and quality of life while lowering severe asthma flare-ups.

Variable airflow restriction, bronchial hyperresponsiveness, and recurring respiratory symptoms are the hallmarks of asthma, a chronic inflammatory airway disease. A significant percentage of patients still have poorly managed illness and recurrent exacerbations in spite of advancements in biologic treatments and inhaled corticosteroids. In addition to their antibacterial action, macrolide medicines like clarithromycin and azithromycin also have immunomodulatory and anti-inflammatory qualities that may help reduce airway inflammation.

Long-term macrolide medication may help certain asthmatic patients experience fewer exacerbations and better symptoms, according to mounting data. Optimizing asthma management techniques requires an understanding of the therapeutic function, mechanisms, and safety profile of macrolides. This study examined the safety and effectiveness of macrolides for asthma in preparation for the impending AAAAI/ACAAI JTFPP recommendations addressing severe asthma.

A comprehensive search of MEDLINE, EMBASE, and CENTRAL was conducted through April 12, 2025, for randomized studies comparing macrolides to placebo or routine asthma therapy. Record screening and data extraction were performed separately by paired reviewers. Individual patient-level data with random effects ANCOVA models focused on asthma management and asthma-related quality of life (QoL). Random effects meta-analyses examined severe exacerbations and harms. They utilized the GRADE method to assess the certainty of evidence.

A total of 1825 people participated in 19 trials. Macrolides improve asthma control by enhancing the minimally important difference [MID] of 0.5 points. This also likely reduced severe flare-ups (incidence rate ratio: 0.75 [95%CI 0.57 to 0.98]; rate difference: 0.26 fewer events per patient-year [95%CI 0.45 to 0.02 fewer events]; moderate certainty); and improved the quality of life modestly (AQLQ; 1-7; higher better; MD: 0.11 [95%CI -0.06 to 0.29]; 47.6% vs. 42.4% improving by MID of 0.5 points; moderate certainty).

Patients with T2-high asthma experienced comparable relative effects to those with T2-low asthma. Overall, with little to no difference in the major effects experienced by people with T2-high or T2-low asthma, macrolides probably enhance asthma control and quality of life while reducing severe exacerbations.

Reference:

Ologundudu, L. M., Wong, M. M., Islam, N., Rayner, D. G., Chu, A. W. L., Loeb, M., Rivera-Spoljaric, K., Chipps, B., Sumino, K., Oppenheimer, J., Nyenhuis, S. M., Israel, E., Hoyte, F., Perry, T. T., McCabe, E., Press, V. G., Rangel, S., Guyatt, G. H., Shade, L. E., ... Chu, D. K. (2026). Macrolides for asthma: a systematic review and meta-analysis of randomized trials. The Journal of Allergy and Clinical Immunology. https://doi.org/10.1016/j.jaci.2026.01.024