The efficacy and safety of azithromycin in asthma: A systematic review

Azithromycin is a potential therapeutic choice for asthma control, which is a heterogeneous airway inflammatory disease. Because of variable findings, we intend to evaluate the therapeutic effect and safety of azithromycin in asthma. Databases, including PubMed, EMBASE, Cochrane, and CNKI until 31 December 2017, were searched to identify available randomised controlled trials regarding azithromycin treatment for asthma. We identified seven studies involving 1520 cases that met our criteria. The mean difference for lung function (FEV₁ , FVC, PEF), symptom assessment (ACQ, AQLQ), airway inflammation, and risk ratios for adverse events were extracted. Chi-square and I² tests were applied to evaluate the heterogeneity among the studies towards each index with a random effect model or a fixed effect model. Pooled analysis shows that azithromycin administration results in no significant improvement in FEV₁ (MD: 0.09, 95% CI -0.10 to 0.29, P = 0.36), PEF (MD: 11.76; 95% CI, -2.86 to 26.38, P = 0.11), total airway inflammatory cells (MD: -0.29; 95% CI, -1.38 to 0.80, P =  0.60), ACQ (MD: 0.05; 95% CI, -0.08 to 0.19, P = 0.44), and AQLQ (MD: 0.12; 95% CI, -0.02 to 0.26, P =  0.10). Moreover, no significant difference was detected in adverse events (Risk ratio 0.99; 95% CI, 0.82-1.19, P = 0.90). These findings demonstrate no beneficial clinical outcome of azithromycin in asthma control, and we propose that further prospective cohorts are warranted.