Effect of Oral Azithromycin Three Times Per Week on Reduction of Asthma Exacerbations in Adults with Persistent Asthma

Abstract

Background: Asthma exacerbation is a cause of major financial burden on any country. Many asthma patients remain symptomatic despite optimum treatment. Controlling the inflammatory response using a macrolide can be novel approach as one of the core underlying mechanisms in asthma is inflammation. This study evaluated the effect of oral azithromycin three times per week on reduction of asthma exacerbations in adults with persistent asthma. Aim: To evaluate the efficacy of azithromycin in reducing asthma exacerbations in persistent asthma patients. Materials & Methods: An open label randomized clinical trial was conducted in National Institute of diseases of the Chest and Hospital (NIDCH), Mohakhali, Dhaka from 2018 to 2019 for one year. A total of 70 patients older than of 12 years suffering from persistent asthma who fulfilled the inclusion and exclusion criteria were recruited. Eligible patients were allocated randomly into group A (Azithromycin group) who were given azithromycin 500 mg three times on alternate days for 24 weeks in addition to standard asthma medications and group B (Standard Asthma treatment group) who received only standard asthma therapy. The patients of both groups were evaluated at base line, during and at the end of 24 weeks. A total of 60 patients who completed the study were analyzed. Asthma exacerbation (moderate vs severe), number of exacerbations, symptomatic improvement and adverse events were monitored during study period. Trial was registered at International Traditional Medicine Clinical Trial Registry ISRCTN (registry number 14464685). Results: In our study, number of exacerbation was significantly reduced in azithromycin group (Group A) in comparison to conventional group (Group B). In group A, 53% patients did not suffer any exacerbation whereas 46% patients from Group B suffered one exacerbation during study period which is statistically significant (p<0.05). In reduction of type of exacerbation, out of the 14 exacerbations in group A, 13(92.9%) had moderate exacerbations, 1(7.1%) had severe exacerbations. In group B, 20(83.3%) had moderate exacerbation and 4 (16.7%) had severe exacerbation. But the difference was not statistically significant (p>0.05). Conclusion: Oral azithromycin 500 mg three times a week on alternate days can reduce exacerbation; improve asthma symptoms, and asthma control status in patients with persistent asthma. Chest Heart J. 2023; 47(2) : 99-109