Prophylactic Azithromycin may reduce asthma exacerbations in adults, finds study

Long term Prophylactic Azithromycin causes significant reduction in exacerbations in adult asthma patients, reports a new research.

An observational study by Aravind Ponnuswamy and team revealed that Long-term prophylactic azithromycin showed to have a significant reduction the number of infections and hospitalisations in asthmatic patients. However there was no improvement in the lung function and 5% patients had hearing impairment.

The findings of the study are published in Chest Journal.

Azithromycin is popularly known to exhibit anti-inflammatory effects in addition to antibiotic properties. Asthma severly affects quality of life of over 15 million people with incidence in 300 million people.

The objective of the study was to evaluate if there is an improvement in the number exacerbations in asthmatic patients on long-term azithromycin in addition to other aspects of prescription.

The study was observational study looking at 34 asthmatic patients on azithromycin was done. The patient data sets were anonymised and analysed on an Excel 2010 Spread sheet. Asthmatic patients aged 18 and over were included. Data collected included: age, sex, respiratory diagnosis, co-morbidities, and immune status, number of infections and hospitalisations prior to and after staring azithromycin, lung function, corrected QT intervals, hearing issues, liver function test and gastrointestinal symptoms.

The results of the study were

• A total of 34 asthmatic patients (9 male, 25 female) with a median age of 58 (Range: 23-81) years were commenced on prophylactic azithromycin at the dose of 250mg three times a week. The average BMI was 31.66 (S.D. 7.83).

• The dose prescribed was 250 mg three times a week. Mean duration was 39.83 (S.D. 24.04). Treatment was stopped in 13 patients due to side effects.

• Approximately 5.8 % had hearing impairment exclusively due to azithromycin. 2/34 patients had prolonged QTc before starting and 5/34 patients had prolonged QTc after starting azithromycin.

• The reduction in the number of infections and hospitalisations over the 12 months following treatment was significant with p<0.001 and p<0.034, respectively.

• 12/34 patients experienced a 100% reduction in the number of infections. Information on number of infections pre and post treatment were based on patients recalling and posed a recalled bias.

Ponnuswamy and team concluded that "Long-term prophylactic azithromycin has been shown to correlate with a significant reduction the number of infections and hospitalisations in asthmatic patients." They stated that their study did not show any lung function improvements with azithromycin use and the adverse effect hearing loss similar to previous studies of 5%.

Azithromycin is a safe and effective prophylactic drug in reducing exacerbations in this cohort of asthma patients our real world experience is in keeping with studies done so far

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DOI: https://doi.org/10.1016/j.chest.2021.07.083