In a study recently published in Lancet, it found that azithromycin add-on therapy reduces exacerbation frequency and improves quality of life in asthmatic patients. There is currently a strong need to prevent asthma exacerbation in patients with uncontrolled asthma. Many new biological medications have come on the market recently to treat this segment of the population. All of them come with a heavy price tag and may not be feasible for all patients with severe persistent asthma.
A randomized trial looked at adding the antibiotic azithromycin (this antibiotic is commonly known as Z-pack) for patients with severe asthma that was uncontrolled by inhaled corticosteroids and long acting bronchodilators. They were either assigned to receive 500mg of azithromycin 3 times per week or a placebo for 48 weeks.
Azithromycin treatment decreased the frequency of all asthma exacerbations and severe exacerbations. The exacerbation rate was decreased for patients with eosinophilic and non-eosinophilic asthma. The treatment group had a significant improvement in asthma related quality of life measures and fewer respiratory tract infections. These results demonstrate that azithromycin may be of benefit for add on therapy for patients with severe asthma.
A major downside of using azithromycin that frequently would be the development of antibiotic resistance. Diarrhea was also reported higher in the treatment group than the placebo arm. But the development of antibiotic resistance will be a major barrier to using antibiotics long term for treating severe asthma.
Azithromycin has shown similar efficacy to monoclonal antibodies (Xolair, Nucala, Cinqair). It also has a broader benefit in that it also reduces lower respiratory tract infections, improves quality of life and it costs significantly less. Azithromycin could be considered in patients with severe uncontrolled asthma who are already taking high doses of inhaled corticosteroids and long acting beta agonists before the introduction of monoclonal antibodies. The long term effects of community antibiotic resistance though requires further evaluation.
If you have severe uncontrolled asthma, speak to your asthma doctor about what the next step would be for you.