Macrolides, such as clarithromycin and azithromycin, possess antimicrobial, immunomodulatory, and potential antiviral properties. They are a potential therapeutic option for asthma but the results from clinical trials have been contentious. The findings could be confounded by many factors, including the heterogeneity of asthma, treatment duration and dose.
Recent evidence suggests effectiveness of macrolides in patients with uncontrolled severe neutrophilic asthma and in asthma exacerbations.
At present, the use of macrolides in chronic asthma or acute exacerbations is not justified.
Further work, including proteomic, genomic, and microbiome studies, will advance our knowledge of asthma phenotypes, and help to identify a macrolide-responsive subgroup.
The role of macrolides in asthma. The Lancet Respiratory Medicine, Early Online Publication, 17 June 2014, doi:10.1016/S2213-2600(14)70107-9
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Image source: Clarithromycin structure, Wikipedia, public domain.
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Dr John Weiner @AllergyNet: 40 yrs of reports but unsolved