Maintenance azithromycin therapy reduces asthma exacerbations

  • Hiles SA & al.
  • Eur Respir J
  • 1 Nov 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • This meta-analysis suggests that long-term use of azithromycin with existing maintenance asthma treatment reduces the risk for exacerbations in patients with asthma and in severe asthma, eosinophilic asthma and non-eosinophilic asthma sub-phenotypes.

Why this matters

  • The 2019 Global Initiative for Asthma guidelines recommend the use of macrolides as an add-on therapy in patients with difficult-to-treat and severe asthma, despite no published data.
  • Azithromycin may be a useful adjunct medication for well-selected at risk, as it is inexpensive, easily administered and effective at reducing exacerbations.

Study design

  • Meta-analysis of 3 studies (n=597) that compared at least 8 weeks of azithromycin treatment with placebo.
  • Exacerbations in asthma assessed over at least 6 months
  • Funding: None.

Key results

  • During follow-up, azithromycin treatment was associated with a reduction in the rate of asthma exacerbation (incidence rate ratio [IRR], 0.61; 95% CI, 0.49-0.78; P<.001>
  • Reduced rate was similar in:
    • non-eosinophilic (IRR, 0.61; 95% CI, 0.45-0.82; P=.001);
    • eosinophilic (IRR, 0.63; 95% CI, 0.44-0.92; P=.015); and
    • severe (IRR, 0.69; 95% CI, 0.52-0.92; P=.013) asthma.
  • In patients with eosinophilic asthma, azithromycin group had significantly reduced rates of oral corticosteroid course [OCS] courses (IRR, 0.42; 95% CI, 0.23-0.78; P=.006) and reduced likelihood of reporting an OCS course (OR, 0.48; 95% CI, 0.26-0.89; P=.019).
  • Azithromycin therapy was associated with reduction in the rate of antibiotic use for respiratory infections in the entire cohort (IRR=0.54, 95%CI 0.38-0.76, P=.001), non-eosinophilic asthma (IRR=0.36; 95% CI, 0.22-0.56, P<.001 and severe asthma p=".037)</li">
  • Hospitalisation was infrequent, with similar prevalence reported in both the azithromycin and placebo group (OR=0.71, 95% CI 0.32-1.56, P=.390, N=597)


  • Limited number of studies.