Long-Term Azithromycin Therapy to Reduce Acute Exacerbations in Patients With Severe Chronic Obstructive Pulmonary Disease

Respiratory Medicine Journal, 2018

Posted: 13 May 2018

See all articles by Nafiseh Naderi

Nafiseh Naderi

McGill University - Division of Experimental Medicine; Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, McGill University, Montreal, Canada

Deborah Assayag

Independent

Seyed-Mohammad-Yousof Mostafavi-Pour-Manshadi

Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, McGill University, Montreal, Canada

Zeina Kaddaha

Independent

Alexandre Joubert

Independent

Isabelle Ouellet

Independent

Isabelle Drouin

Independent

Pei Zhi Li

Independent

Jean Bourbeau

Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, McGill University, Montreal, Canada

Date Written: April 13, 2018

Abstract

Rationale According to clinical trials, azithromycin taken daily for 1 year, decreased exacerbations of chronic obstructive pulmonary disease (COPD).

Objectives Effectiveness evaluation of long-term azithromycin to reduce exacerbations in severe COPD patient on optimal therapy in real-life practice.

Methods We conducted a retrospective observational study of severe COPD patients who were prescribed azithromycin (PA)(250 mg, at least 3 times weekly for at least 6 months). Comparison group included severe COPD patients not prescribed azithromycin (NPA). Data were extracted from clinical chart review.

Main results Study included 126 PA and 69 NPA patients. They had severe airflow obstruction, mostly emphysema and one-third bronchiectasis. A predominant feature in the PA group was respiratory tract colonization with Pseudomonas aeruginosa. The mean number of exacerbations per patient per year in the PA group was 3.2 ± 2.1 before initiating azithromycin, and 2.3 ± 1.6 during following year on therapy (p < 0.001). Patients in the NPA group had 1.7 ± 1.3 and 2.5 ± 1.7 exacerbations during first and second follow-up year respectively (p < 0.001). Exacerbation changes from pre to post differed between groups (p < 0.001). Decrease in emergency visits and hospital admissions was significant in PA group. Exacerbation reductions and patient proportions having ≥2 exacerbations extended to the second year of treatment.

Conclusion These data showed that long-term azithromycin reduces exacerbation numbers in severe COPD patients, and benefits persist beyond one year. Desirable effects are more likely to outweigh the risks and adverse events in patients colonized with Pseudomonas aeruginosa.

Keywords: Chronic Obstructive Pulmonary Disease, COPD, Long Term Azithromycin Therapy, Exacerbations, Macrolide

Suggested Citation

Naderi, Nafiseh and Assayag, Deborah and Mostafavi-Pour-Manshadi, Seyed-Mohammad-Yousof and Kaddaha, Zeina and Joubert, Alexandre and Ouellet, Isabelle and Drouin, Isabelle and Li, Pei Zhi and Bourbeau, Jean, Long-Term Azithromycin Therapy to Reduce Acute Exacerbations in Patients With Severe Chronic Obstructive Pulmonary Disease (April 13, 2018). Respiratory Medicine Journal, 2018. Available at SSRN: https://ssrn.com/abstract=3162252

Nafiseh Naderi

McGill University - Division of Experimental Medicine ( email )

Montreal, Quebec
Canada

Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, McGill University, Montreal, Canada ( email )

Deborah Assayag

Independent ( email )

No Address Available

Seyed-Mohammad-Yousof Mostafavi-Pour-Manshadi

Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, McGill University, Montreal, Canada ( email )

Montreal, Quebec
Canada

Zeina Kaddaha

Independent ( email )

No Address Available

Alexandre Joubert

Independent ( email )

No Address Available

Isabelle Ouellet

Independent ( email )

No Address Available

Isabelle Drouin

Independent ( email )

No Address Available

Pei Zhi Li

Independent ( email )

No Address Available

Jean Bourbeau (Contact Author)

Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, McGill University, Montreal, Canada ( email )

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