Long-term experience of azithromycin use in patients with asthma and bronchiectasis

The combination of asthma and bronchiectasis is associated with more severe disease, chronic sputum production, and frequent infectious exacerbations.

Aim. To evaluate the effect of long­term azithromycin therapy on clinical manifestations and laboratory markers of inflammation in patients with severe asthma and concomitant bronchiectasis experiencing frequent infective exacerbations.

Methods. The study included 60 adult patients with severe asthma and bronchiectasis. Patients were divided into two groups: the control group received standard asthma therapy; the main group received standard therapy combined with azithromycin at a dose of 500 mg two times a week for 6 months. All patients also received N­acetylcysteine at a dose of 600 mg/day. Symptoms, exacerbation frequency, pulmonary function tests, and laboratory inflammatory markers in blood and sputum were assessed before treatment and after 6 months.

Results. Baseline characteristics were comparable between groups. After 6 months, the azithromycin group, compared to the control group, showed less severe dyspnea on the mMRC (modified Medical Research Council dyspnea scale – mMRC) scale – 2.0 (1.0 – 2.0) vs 3.0 (2.0 – 3.0), p = 0.003; higher asthma control according to ACT (Asthma Control Test) – 21.0 (18.0 – 21.0) vs 16.5 (15.0 – 17.0), p < 0.001; and a lower exacerbation rate over 6 months – 1.0 (0.0 – 2.0) vs 2.0 (1.0 – 2.0), p = 0.001. Reduced laboratory markers of inflammation were also observed: blood leukocytes (p = 0.012), neutrophils (p = 0.004), C reactive protein (p = 0.006), sputum leukocytes (p = 0.010), and the degree of sputum purulence – 1.0 (1.0 – 2.0) vs 3.0 (1.3 – 3.0), p = 0.007. Forced expiratory volume in 1 second (FEV1) was higher in the azithromycin group – 1.5 (1.1 – 1.7) L vs 1.1 (0.9 – 1.5) L, p = 0.021.

Conclusion. Long­term azithromycin therapy in patients with severe asthma combined with bronchiectasis was associated with improved asthma control, reduced symptom severity, decreased exacerbation frequency, increased FEV1, and reduced sputum purulence.

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