 |
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2020, vol. 26, issue3
Subject Area: Medicine
-
DOI: 10.5272/jimab.2020263.3259
Published online: 31 July 2020
Original articles
J of IMAB. 2020 Jul-Sep;26(3):3259-3266
LONG-TERM AZITHROMYCIN TREATMENT IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Vanya Kostadinova1
, Yordan Radkov1, Temenuga Stoeva2, Darina Miteva1,
1) Department of Pulmonary Diseases and Allergology, Medical University – Varna, Bulgaria.
2) Department of Microbiology and Virology, Medical University – Varna, Bulgaria.
ABSTRACT:
Purpose: To assess the efficacy of Azithromycin on exacerbations in patients with chronic obstructive pulmonary disease (COPD) and history of two or more flare-ups in the last 12 months and to study the influence of concomitant bronchiectasis on its effect.
Material/Methods: We prospectively observed 60 COPD patients with frequent exacerbations and predominantly severe disease (mean forced expiratory volume in 1 second [FEV1] – 44%). Addition of six-month intermittent Azithromycin (500 mg three times weekly) to standard therapy was compared to standard therapy only in respect to exacerbation frequency and time to first exacerbation.
Results: Azithromycin, in comparison to standard therapy, led to a higher reduction of exacerbation frequency (-1.47 vs -0.87 events per patient-year) but did not affect hospitalization frequency (-0.57 vs. -0.53 events per patient-year). The time to first exacerbation was longer in the macrolide group (233 days) than in the control group (125 days) (P=0.011). Bronchiectasis did not influence the effect of tested macrolide on exacerbations. No significant effect on lung function, symptoms, quality of life, physical capacity and sputum and throat swab microbiology was found.
Conclusions: Azithromycin reduced the frequency of exacerbations and delayed the time to first exacerbation. The effect was independent on the presence of bronchiectasis.
Keywords: chronic obstructive pulmonary disease, bronchiectasis, exacerbations, Azithromycin,
- Download FULL TEXT /PDF 933 KB/
Please cite this article as: Kostadinova V, Radkov Y, Stoeva T, Miteva D. Long-term azithromycin treatment in chronic obstructive pulmonary disease. J of IMAB. 2020 Jul-Sep;26(3):3259-3266.
DOI: 10.5272/jimab.2020263.3259
Correspondence to: Vanya Kostadinova Stefanova, Clinic of pulmonary diseases, UMHAT “St. Marina”; 1, Hristo Smirnenski Blvd., Varna 9000, Bulgaria; E-mail: v_vanqkostadinova@abv.bg
REFERENCES:
1. Santos S, Marin A, Serra-Batlles J, de la Rosa D, Solanes I, Pomares X, et al. Treatment of patients with COPD and recurrent exacerbations: the role of infection and inflammation. Int J Chron Obstruct Pulmon Dis. 2016;11(1):515-525. [PubMed] [Crossref]
2. Fan LC, Lu HW, Wei P, Ji XB, Liang S, Xu JF. Effects of long-term use of macrolides in patients with non-cystic fibrosis bronchiectasis: a meta-analysis of randomized controlled trials. BMC Infect Dis. 2015 Mar 27;15(1):160. [PubMed] [Crossref]
3. Cui Y, Luo L, Li C, Chen P, Chen Y. Long-term macrolide treatment for the prevention of acute exacerbations in COPD: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis. 2018 Nov;13:3813-3829. [PubMed] [Crossref]
4. Uzun S, Djamin RS, Kluytmans J, Mulder PJ, van’t Veer NE, Ermenes AA, et al. Azithromycin maintenance treatment in patients with frequent exacerbations of chronic obstructive pulmonary disease (COLUMBUS): a randomised, double-blind, placebo-controlled trial. The Lancet. 2014;2(5):361-368. [PubMed] [Crossref]
5. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease, Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2014. [Internet]
6. Miller МR, Hankinson J, Brusasco V, F. Burgos, R. Casaburi, A. Coates, et al. Standardisation of spirometry. Eur Respir J. 2005;26(2):319-338. [PubMed] [Crossref]
7. ATS Statement: Guidelines for the Six-Minute Walk Test. Аm J Respir Crit Care Med. 2002;166(1):111-117. [PubMed] [Crossref]
8. Paggiaro PL, Chanez P, Holz O, Ind P, Djukanovic R, Maestrelli P, et al. Sputum induction – Report of working group 1. Eur Respir J. 2002; 20:3-8.
9. Burge S, Wedzicha JA. COPD exacerbations: definitions and classifications. Eur Respir J. 2003 Jun;21:46-53. [PubMed] [Crossref]
10. Reiff DB, Wells AU, Carr DH, Cole PJ, Hansell DM. CT findings in bronchiectasis: limited value in distinguishing between idiopathic and specific types. Am J Radiol. 1995 Aug;165(2):261-267. [PubMed] [Crossref]
11. Chalmers JD, Goeminne P, Aliberti S, McDonnell MJ, Lonni S, Davidson J, et al. The Bronchiectasis Severity Index: an international derivation and validation study. Am J Respir Crit Care Med. 2014 Mar;189(5):576-585. [PubMed] [Crossref]
12. Ni W, Shao X, Cai X, Wei C, Cui J, Wang R, et al. Prophylactic Use of Macrolide Antibiotics for the Prevention of Chronic Obstructive Pulmonary Disease Exacerbation: A Meta-Analysis. PLoS One. 2015 Mar 26;10(3):e0121257. [PubMed] [Crossref]
13. Berkhof FF, Doornewaard-ten Hertog NE, Uil SM, Kerstjens HA, van den Berg JM. Azithromycin and cough-specific health status in patients with chronic obstructive pulmonary disease and chronic cough: a randomised controlled trial. Respiratory Research. 2013 Nov 14;14(1):125. [PubMed] [Crossref]
14. Pomares X, Montón C, Espasa M, Casabon J, Monsó E, Gallego M. Long-term azitromycin therapy in patients with severe COPD and repeated exacerbations. Int J Chron Obstr Pulmon Dis. 2011 Sep 6;6:449-56. [PubMed] [Crossref]
15. Han MK, Tayob N, Murray S, Dransfield MT, Washko G, Scanlon PD, et al. Predictors of chronic obstructive pulmonary disease exacerbation reduction in response to daily azithromycin therapy. Am J Respir Crit Care. Med 2014 Jun 15;189(12):1503-8. [PubMed] [Crossref]
16. Albert RK, Connett J, Bailey WC, Casaburi R, Cooper JA Jr, Criner GJ, et al. Azithromycin for prevention of exacerbations of COPD. N Engl J Med. 2011;365(8):689-98. [PubMed]
17. He ZY, Ou LM, Zhang JQ, Bai J, Liu GN, Li MH, et al. Effect of 6 Months of Erythromycin Treatment on Inflammatory Cells in Induced Sputum and Exacerbations in Chronic Obstructive Pulmonary Disease. Respiration. 2010;80(6):445-452. [PubMed] [Crossref]
18. Tan C, Huang H, Zhang J, He Z, Zhong X, Bai J. Effects of Low-Dose and Long-Term Treatment With Erythromycin on Interleukin-17 and Interleukin-23 in Peripheral Blood and Induced Sputum in Patients With Stable Chronic Obstructive Pulmonary Disease. Mediators Inflamm. 2016; 2016:4173962. [PubMed] [Crossref]
19. Wu Q, Shen W, Cheng H, Zhou X. Long-term macrolides for non-cystic fibrosis bronchiectasis: A systematic review and meta-analysis. Respirology.2014 Apr;19(3):321-329. [PubMed] [Crossref]
20. Segal LN, Clemente JC, Wu BG, Wikoff WR, Gao Z, Li Y, et al.Randomised, double-blind, placebo-controlled trial with Azithromycin selects for anti-inflammatory microbial metabolites in the emphysematous lung. Thorax. 2017 Jan;72(1):13-22. [PubMed] [Crossref]
21. Donath E, Chauthry A, Hernandez-Aya LF, Lit L. A meta-analysis on the prophylactic use of macrolide antibiotics for the prevention of disease exacerbations in patients with Chronic Obstructive Pulmonary Disease. Respir med. 2013 Sep;107(9):1385-1392. [PubMed] [Crossref].
Received: 16 July 2019
Published online: 31 July 2020