Adding a common antibiotic to the usual daily treatment regimen for chronic obstructive pulmonary disease (COPD) can reduce the occurrence of acute exacerbations and improve quality of life, reports new results from a clinical trial funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health. Previous research suggested that this antibiotic might work for COPD exacerbations, but this study was the first to enroll a large number of COPD patients and treat exacerbations with this drug over a long time. “Acute exacerbations account for a significant part of COPD’s health burden,” said Susan B. Azithromycin is already prescribed for a wide variety of bacterial infections including pneumonia and strep throat. “These promising results with azithromycin may help us reduce that burden and improve the lives of patients at risk.” COPD exacerbations are sudden onsets of worsened cough, wheeze, and labored breathing which are typically induced by bacterial and/or viral infection. Participants had a history of exacerbations in the previous year or needed oxygen therapy. The 570 study participants who took 250 milligrams of azithromycin daily for a year in addition to their usual care averaged 1.48 acute COPD exacerbations annually, compared to 1.83 exacerbations for the 572 participants who received their usual care without azithromycin. The participants taking azithromycin also assessed their own breathing ability and overall well-being more favorably on questionnaires. Eighty percent of the study participants were already taking other medications normally used to manage COPD, including inhaled steroids and long-acting bronchodilators. This multicentre study randomised 1142 subjects at risk of acute exacerbations of chronic obstructive pulmonary disease (COPD) to receive azithromycin 250 mg daily (n=570) or placebo (n=572) for 1 year, in addition to usual care. The enrolled subjects were allowed to continue on inhaled treatments and/or oxygen. The primary outcome, time to the first exacerbation, was significantly increased to 266 days (95% CI 227 to 313) in the azithromycin group compared with 174 days (95% CI 143 to 215) in the placebo group. The HR for having an acute exacerbation of COPD per patient-year was 0.73 in the azithromycin group compared with the placebo group. The secondary outcomes included quality of life measures (St George's Respiratory Questionnaire (SGRQ) scores), which improved more in the azithromycin compared with the placebo group. There was no significant reduction in hospitalisation rates and emergency department or urgent care visits and no difference in mortality. Hearing loss was more common in the azithromycin group and increased colonisation with macrolide resistant pathogens was noted. The authors concluded that the addition of azithromycin to usual care of COPD patients who have had an acute exacerbation in the last year or require oxygen supplementation is a valuable option but careful patient selection is required with the exclusion of patients with or at risk of QTc prolongation, resting tachycardia (100 beats per minute) and hearing defect.
Chronic Obstructive Pulmonary Disease 1is a nice review on azithromycin to prevent chronic obstructive pulmonary disease exacerbations COPD exacerbations. Azithromycin to Prevent COPD Exacerbations What's New? By Abhishek Biswas, MD. Multiple previous studies have suggested likely benefits from using azithromycin as an.