By Ves Dimov, MD Allergist/Immunologist, Assistant Professor of Medicine and Pediatrics University of Chicago
Macrolide antibiotics have anti-inflammatory and immune modulatory effects and have been studied as adjuncts for the management of asthma with contradictory results. This meta-analysis included 12 randomized controlled trials (RCT) of prolonged macrolides (3+ weeks) for asthma treatment.
The effect of macrolides on FEV1 was not significant. However, there were improvements in peak expiratory flow, symptom scores, quality of life, and airway hyper-reactivity.
The study authors concluded that macrolides may be beneficial as adjunct asthma therapy. Future trials, focusing on long-term safety and effectiveness, should use standardized outcomes.
Source: Reiter J, Demirel N, Mendy A, Gasana J, Vieira ER et al. Macrolides for the long-term management of asthma – a meta-analysis of randomized clinical trials. Allergy 2013; Published online before print. (doi: 10.1111/all.12199)
Image Source: Clarithromycin structure, Wikipedia, public domain.
In 1996, a questionnaire was distributed to 3,430 parents of all children aged 7 to 8 years in 3 municipalities in Sweden (97% participation rate). 248 children were identified as having asthma, and they were reassessed annually until age 19 years when 205 (83%) remained.
Remission was defined as no use of asthma medication and no wheeze during the past 12 months (when reported for 3 or more years in the surveys).
At age 19 years, 21% of children were in remission, 38% had periodic asthma, and 41% persistent asthma. Remission was more common among boys. Sensitization to furred animals and a more severe asthma at age 7-8 years were inversely associated with remission. Among children with these 2 characteristics, 82% had persistent asthma during adolescence.
The low probability of remission of childhood asthma from age 7-to-8-years to age 19 years was determined by sensitization status, particularly sensitization to animals, asthma severity, and female gender.
Source: Andersson M, Hedman L, Bjerg A, Forsberg B, Lundbäck B, Rönmark E. Remission and persistence of asthma followed from 7 to 19 years of age. Pediatrics 2013; Published online before print (doi: 10.1542/peds.2013-0741)
The use of anticholinergic medications is well established as maintenance therapy for chronic obstructive pulmonary disease (COPD), and there is a growing interest in the use of anticholinergic medications in the treatment of moderate to severe asthma.
Several recent clinical trials have provided evidence for the use of tiotropium as add-on therapy for asthma. Tiotropium was superior to doubling the dose of an inhaled corticosteroid (ICS) based on change in morning peak expiratory flow (PEF). Two large multinational trials provide evidence for the use of tiotropium in a subset of asthmatic patients who have not achieved control using combination therapy with an ICS and a long-acting β2 agonist (LABA).
Further studies are needed to better define which phenotypic subset of patients would benefit most from the use of tiotropium.
Source: Guyer AC, Long AA. Long-acting anticholinergics in the treatment of asthma. Current Opinion in Allergy & Clinical Immunology 2013; 13(4): 392-398. (doi: 10.1097/ACI.0b013e328362a775)