Department of Internal Medicine, Mashhad Medical Sciences Branch, Islamic Azad University, Mashhad, Iran; Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
Internist and Pulmonologist, Department of Internal Medicine, Medical School, Islamic Azad University- Mashhad Branch, Mashhad, Iran.
Respir Med. 2021 Aug-Sep;185:106494. doi: 10.1016/j.rmed.2021.106494. Epub 2021 Jun 2.
Azithromycin reduced airway remodeling in animal models of asthma. However, its effect on human subjects has not been studied yet. This study aimed to investigate the effect of long-term treatment with azithromycin on airways wall thickness in patients with severe persistent asthma.
In this randomized, double-blind, placebo-controlled clinical trial, patients with severe persistent asthma received azithromycin (250 mg, BID, three days a week), prednisolone (5 mg, BID), or placebo for eight months in three separate groups in addition to the standard therapy. The improvement in right upper lobe apical segmental bronchus (RB1) wall thickness obtained by high resolution computed tomography was set as the primary outcome. Secondary outcomes included: cough severity, dyspnea severity, asthma control test (ACT) score, asthma exacerbation rate, pulmonary function tests, and fractional exhaled nitric oxide (FENO).
Seventy-eight out of ninety randomized subjects completed eight months of treatment with azithromycin (n = 25), prednisolone (n = 27), or placebo (n = 26). Bronchial wall thickness percentage did not change significantly in any of the groups. However, the inner radius and lumen area of azithromycin and prednisolone-treated subjects increased significantly (p < 0.05 for both). Azithromycin also significantly improved the dyspnea severity, ACT score, FENO, and FEV1, FEF, and FEV1/FVC (p < 0.05 for all). Cough severity or asthma exacerbation rate did not change significantly after eight months of treatment with azithromycin.
Long-term treatment with azithromycin increased lumen radius and lumen area in patients with severe persistent asthma. However, there was no significant change in wall thickness in any of the treatment groups.
IRCT.com (IRCT20091111002695N8).
阿奇霉素可减少哮喘动物模型中的气道重塑。然而，其在人类受试者中的作用尚未得到研究。本研究旨在探讨长期使用阿奇霉素治疗对严重持续性哮喘患者气道壁厚度的影响。
在这项随机、双盲、安慰剂对照的临床试验中，三组患者在标准治疗的基础上分别接受阿奇霉素（250mg，BID，每周 3 天）、泼尼松龙（5mg，BID）或安慰剂治疗 8 个月。高分辨率计算机断层扫描获得的右上叶尖段支气管（RB1）壁厚度改善情况被设定为主要结局。次要结局包括：咳嗽严重程度、呼吸困难严重程度、哮喘控制测试（ACT）评分、哮喘加重率、肺功能检查和呼出气一氧化氮（FENO）。
90 名随机受试者中有 78 名完成了阿奇霉素（n=25）、泼尼松龙（n=27）或安慰剂（n=26）的 8 个月治疗。各组支气管壁厚度百分比均无明显变化。然而，阿奇霉素和泼尼松龙治疗组的内半径和管腔面积显著增加（均 p<0.05）。阿奇霉素还显著改善了呼吸困难严重程度、ACT 评分、FENO 以及 FEV1、FEF 和 FEV1/FVC（均 p<0.05）。在接受阿奇霉素治疗 8 个月后，咳嗽严重程度或哮喘加重率无明显变化。
长期使用阿奇霉素可增加严重持续性哮喘患者的管腔半径和管腔面积。然而，在任何治疗组中，壁厚度均无明显变化。
IRCT.com（IRCT20091111002695N8）。
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