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Azithromycin reduces bronchial wall thickening in infants with cystic fibrosis

Yuxin Chen1, Jean-Paul Charbonnier2, Eleni-Rosalina Andrinopoulou3

  • 1Department of Paediatrics, Division of Respiratory Medicine and Allergology, Sophia Children's Hospital, Erasmus MC, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands.

Journal of Cystic Fibrosis : Official Journal of the European Cystic Fibrosis Society
|April 7, 2024
PubMed

Insights

Azithromycin treatment in infants with cystic fibrosis (CF) reduced bronchial wall thickness and may improve lung perfusion, as shown by advanced CT scan analysis. This finding offers new insights into early CF management.

Area of Science:

  • Pediatric Pulmonology
  • Medical Imaging
  • Pharmacology

Background:

  • Previous studies indicated clinical benefits of azithromycin in infants with cystic fibrosis (CF) but no effect on CT-scores.
  • Reanalysis of CT scans using automatic bronchus-artery (BA) analysis was performed to investigate subtle structural changes.

Purpose of the Study:

  • To re-evaluate the impact of azithromycin on airway structural changes in infants with CF using advanced CT imaging analysis.
  • To assess bronchial wall thickness and airway dimensions in relation to artery size and low attenuation regions.

Main Methods:

  • Inspiratory and expiratory CT scans from 228 infants (12 and 36 months) were analyzed using automatic BA-analysis.
  • Measurements included bronchial outer wall (Bout), inner wall (Bin), artery (A), and bronchial wall thickness (Bwt), with computed ratios for widening and thickening.
  • Low attenuation regions (LAR) were quantified, and mixed-effect models compared outcomes between azithromycin and placebo groups at 36 months.

Main Results:

  • The azithromycin group exhibited significantly lower bronchial wall area to outer area ratio (Bwa/Boa, p = 0.0034) and higher bronchial inner wall to artery ratio (Bin/A, p = 0.001).
  • An increased bronchial outer wall to artery ratio (Bout/A, p = 0.0088) was observed, attributed to reduced artery diameters correlating with decreased LAR.

Conclusions:

  • Azithromycin treatment in infants with CF is associated with reduced bronchial wall thickness.
  • The findings suggest a potential positive effect of azithromycin on lung perfusion in this population, warranting further investigation.
Abstract

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