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New life for macrolides.

P Solidoro1, F Braido, M Boffini

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Azithromycin (AZM) shows potential as a long-term treatment for severe non-eosinophilic asthma, with studies indicating safety and anti-inflammatory benefits. Further research is needed to confirm its efficacy in improving lung function and reducing rescue medication use.

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Area of Science:

  • Pulmonology
  • Pharmacology
  • Immunology

Background:

  • Severe asthma is heterogeneous, with non-eosinophilic phenotypes often poorly responsive to corticosteroids.
  • Macrolides, like azithromycin (AZM), possess anti-inflammatory and immunomodulatory properties beneficial in chronic inflammatory lung diseases.
  • AZM's mechanisms in asthma may include antineutrophil activity and addressing chronic infections.

Purpose of the Study:

  • To analyze the role and mechanisms of azithromycin in severe non-eosinophilic asthma.
  • To evaluate the efficacy and safety of long-term azithromycin add-on therapy in this patient population.

Main Methods:

  • Review of existing literature and the AZIthromycin in Severe ASThma (AZISAST) study.
  • Analysis of azithromycin's anti-inflammatory, immunomodulatory, and antibacterial effects.
  • Assessment of safety data regarding macrolide resistance and cardiovascular events.

Main Results:

  • The AZISAST study provided evidence for the safety of long-term azithromycin add-on treatment in severe non-eosinophilic asthma.
  • No increased risk of pneumonia or cardiovascular events was observed.
  • The study did not demonstrate significant improvements in lung function or reduced rescue medication use.

Conclusions:

  • Azithromycin is a potentially safe long-term add-on therapy for severe non-eosinophilic asthma.
  • Further data is required to confirm azithromycin's efficacy in improving lung function and reducing exacerbations.
  • Personalized treatment approaches are crucial for managing severe asthma heterogeneity.