Use of Azithromycin for Asthma Patients

Use of Azithromycin for Asthma PatientsDoes adding azithromycin to standard therapy for bronchial bronchial asthma attack patients with acute exacerbations improve symptom resolution?BackgroundAsthma is presented as a chronic bulky term disease that causes inflammation, narrowing and mucus production in the lungs airways resulting in difficulty breathing. It is assumed to be initiated by genetics or environmental influences. Physical activities and other contributing factors can exacerbate reedy symptoms that include coughing, wheezing, shortness of breath, and chest tighten. Most patient symptoms occur at a rapid tone-beginning and requires immediate treatment. Asthma is non curable but symptoms can be controlled with appropriate therapy. Patients with asthma argon given treatment based on the severity and frequency of symptoms. Therapy options include SABA, LABA, corticosteroids or leukotrienes and adjustments are make as needed. However, many patients quiet down experience uncontrolled symptoms that effect their daily activities.Macrolide antibiotics such as azithromycin birth been recently studied as adjunct therapy for asthmatics, due to their anti-inflammatory and antimicrobial properties. Researchers are geared to think that untreated bacterial infections within the lungs are the underlying influences of asthma related problems. Despite these findings, the issue is still being investigated as patients on traditional standard therapy are still experiencing unwanted symptoms.Literature frontA literature search was conducted utilizing the MEDLINE database of Pubmed using MESH monetary value asthma and azithromycin and MESH subheading therapy. The terms were combined using AND which returned 37 articles. The application of additional limitations of 5 years, randomize controlled runs and humans were applied which trim back the search total amount to 17 articles. Although 17 articles were retrieved during the search, each article was evaluated ba sed on their relevancy and criteria, the above article was selected because it addressed the question at hand.ResultsAZIthromycin in Severe ASThma (AZISAST) was a disarrange double-blinded placebo control trial conducted to determine if adding azithromycin to asthmatic patients as standard therapy would be statistically and clinically beneficial. The trial was conducted from September 2011 to April 2014, as a United Kingdom multicenter ponder. The study consisted of individuals ages 18-75 that had been diagnosed with persistent asthma. Inclusion criteria consisted of patients whose current therapy include high doses of inhaled corticosteroids, inhaled long acting beta agonist LABA for six months prior to the study, two severe asthma exacerbations required systemic steroid therapy, or if they experienced a lower respiratory tract infection that required antibiotic treatment within a twelve month period2. Subjects were excluded if they had prolong QT interval, severe bronchiectasis, before long receiving macrolide treatment in past three months, laboratory abnormalities, pregnant or breastfeeding and concomitant anti-IgE treatments2. Participants were randomly selected to soak up to 250mg abridgements of azithromycin (n=55) and a placebo (n=54) in combination with inhaled corticosteroids and LABAs for six months2. Subjects in both treatment groups were matched in respect to the service line characteristics.The intervention instructed patients to take one capsule daily for five days and continue with one capsule three times a week with a total treatment period of twenty-six weeks. The unproblematic outcome measured severe asthmatic episodes during the treatment phase in both groups, which was defined as hospitalization, emergency department visits, and the utilization of systemic corticosteroids for three days2. Secondary outcomes measured lung function (FEV1), peak expiratory flow (PEF) quality of life (QOL) and asthma control score2. Analyzing the secondar y outcomes, the azithromycin group reported a consequence of thirty exacerbations occurred in comparing to twenty-seven form the placebo group. (p=1.000)2. Additionally, azithromycin and placebo group experience two hospitalization approach due to exacerbations (p=1.000)2. Other efficacy outcomes showed there was no earthshaking improvement in the Asthma prime(a) of Life Questionnaire score between both groups.The treatment period lasted for six months and demonstrated no significant difference between the azithromycin group and the placebo group in relation to asthma exacerbations. The estimated primary endpoints without adjustments resulted in 0.71 (95% CI 0.52 to 0.97) in the azithromycin group and 0.80 (95% CI 0.59 to 1.07) in the placebo group with a p-value of 0.6002. With the addition of sensitivity analyses restricted to asthma exacerbations results were 0.55 (95% CI 0.38 to 0.78) in the azithromycin group and 0.52 (95% CI 0.36 to 0.75) in the placebo group with a p-val ue of 0.8472. Based on the same data, add-on therapy of azithromycin is statistically and clinically insignificant, as well as did not reduce the rate of asthma exacerbation in adults. RecommendationsAlthough, the clinical trial failed to demonstrate that azithromycin was clinically /statistically significant in patients with asthma. This should not be a definite factor to rule out the therapeutic benefits azithromycin can have on patients with respiratory infections that contributes to asthma exacerbations.Developing an accurate interpretation from the study can be difficult considering the study focused on a small population and the duration of treatment was only twelve weeks.I would not recommend azithromycin as add-on therapy for patients with asthma due to it showed no improvement in comparison to patients receiving a placebo, as well as long-term use of a macrolide might lead to resistance.ReferencesBrusselle GG, VanderStichele C, Jordens P, et al. 2013. Azithromycin for str eak of exacerbations in severe asthma (AZISAST) a multicenter randomized double-blind placebo-controlled trial Thorax 201368322-329. 10.1136/thoraxjnl-2012-202698mm