Azithromycin for Other Lung Diseases: Lung Transplantation and Sarcoidosis

Azithromycin was introduced in lung transplantation in an attempt to improve the pulmonary function in patients with chronic allograft dysfunction (CLAD), which is defined as a progressive and usually irreversible decline in FEV1 of at least 20% compared to the best postoperative values and is considered to be the net result of chronic rejection. In fact, in a first case series by Gerhardt et al., a response to azithromycin was observed in 30% of the patients with CLAD (Cooper et al. Am J Respir Crit Care Med 168:85, 2003). Although its mechanism of action is still unknown, it is nowadays specifically used in the treatment and in the prevention of CLAD. After the first case series, many centers have published their experience, all pointing to an increased FEV1 and improved survival, at least in a subset of patients with the bronchiolitis obliterans (BO) phenotype of CLAD. Also, in sarcoidosis, there has been interest in azithromycin, however, mostly in combination with broad-spectrum antimycobacterial drugs (Royer et al. Sarcoidosis Vasc Diffuse Lung Dis 30:201-11, 2014). In this chapter, we will give an overview of the possible treatment indications and effects of azithromycin in lung transplantation and sarcoidosis.