Macrolides and Asthma Therapy

Asthma is a chronic condition of the airways that is typified by bronchial hyperresponsiveness, variable airflow obstruction, and airway inflammation. Most patients can achieve disease control using inhaled corticosteroids, with some needing adjunct long-acting bronchodilator therapy. However, an important minority of patients have persistent symptoms and exacerbations despite these treatments. The landmark AMAZES study showed that the macrolide azithromycin significantly reduced the exacerbation rate in this population, using a randomized parallel group design. The efficacy of macrolides in chronic asthma was recently confirmed in a Cochrane systematic review, which analyzed 25 randomized controlled trials with a total of 1973 patients. Mechanistic studies have shown that this therapeutic effect is mediated by reduced mucosal inflammation, improved airway mucus clearance, and favorable modulation of host-pathogen interactions.