Neomacrolides in the treatment of patients with severe asthma and/or bronchiectasis: a retrospective observational study

Ther Adv Respir Dis. 2011 Dec;5(6):377-86. doi: 10.1177/1753465811406771. Epub 2011 Sep 2.


Rationale: Previous studies have demonstrated that long-term low-dose macrolides are efficacious in cystic fibrosis (CF) and diffuse panbronchiolitis, two chronic neutrophilic airway diseases.

Aims: The aims of this study were to evaluate the efficacy and safety of low-dose neomacrolides as add-on therapy in patients with severe asthma and/or bronchiectasis and to identify predictors for therapeutic response.

Methods: In a retrospective observational cohort study, we examined 131 adult, non-CF patients with severe asthma and/or bronchiectasis, receiving low-dose neomacrolides as add-on treatment. Pulmonary function tests and symptom scores were assessed at baseline and after 3 to 8 weeks of therapy.

Results: After 3-8 weeks of treatment with low-dose neomacrolides, 108 patients were available for evaluation. In asthma patients (n = 47), pulmonary function tests and symptom scores improved significantly. Responders (≥7% forced expiratory volume in one second predicted [FEV(1)%] improvement) were older (55 vs. 47 years; p = 0.042) and had a longer duration of asthma (29 vs. 9 years; p = 0.052). In patients with bronchiectasis only (n = 61), symptom scores improved significantly. Responders (≥60% symptom score improvement) were older (61 vs. 53 years; p = 0.004), more frequently male (53% vs. 27%; p = 0.043), and there was a nonsignificant trend towards higher high-resolution CT (HRCT) score for bronchiectasis in responders (6.4 vs. 4.6; p = 0.053). In multivariate logistic regression analysis, age and male gender were independent predictors for improvement in this group.

Conclusion: The results of this retrospective study suggest that neomacrolides may be useful as an add-on therapy in patients with severe asthma and/or bronchiectasis. Older age may predict good response in patients with severe asthma, whereas older age, male gender and a higher HRCT score for bronchiectasis may predict therapeutic response in patients with bronchiectasis only. Prospective controlled trials of neomacrolides in patients with severe asthma are needed to confirm these observations.

MeSH terms

  • Adult
  • Age Factors
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use
  • Asthma / drug therapy*
  • Asthma / physiopathology
  • Azithromycin / administration & dosage
  • Azithromycin / adverse effects
  • Azithromycin / therapeutic use*
  • Bronchiectasis / drug therapy*
  • Bronchiectasis / physiopathology
  • Clarithromycin / administration & dosage
  • Clarithromycin / adverse effects
  • Clarithromycin / therapeutic use*
  • Cohort Studies
  • Dose-Response Relationship, Drug
  • Female
  • Follow-Up Studies
  • Forced Expiratory Volume
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Respiratory Function Tests
  • Retrospective Studies
  • Severity of Illness Index
  • Sex Factors
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Azithromycin
  • Clarithromycin