Blood eosinophil count and GOLD stage predict response to maintenance azithromycin treatment in COPD patients with frequent exacerbations

Prospects for macrolide therapy of asthma and COPD

Macrolide compounds, many of which are derived from natural sources, all share a lactone ring structure, but of varying sizes. Their biological activities differ with structure and size but tend to overlap. Marketed macrolide drugs include immunosuppressives and antibiotics. Some of the latter have been shown to exert anti-inflammatory activities, due to direct effects on inflammatory cells and processes when used for respiratory infections. Consequently, azithromycin is included in clinical guidelines for COPD and asthma treatment, though it has the disadvantage, as an antibiotic, of increasing bacterial resistance. COPD and asthma, however, like several chronic inflammatory diseases involving other organs, are driven to a large extent by epithelial barrier dysfunction. Recently, azithromycin was shown to directly enhance epithelial barrier function and a new class of derivatives, barriolides, is under development with the lead indication COPD. It is thus likely that by circumventing antibiosis and acting on a crucial etiological disease process, this type of agent will open up a new, safer approach to COPD and asthma therapy with macrolides.

Treating patients with acute COPD in the ED: Are 5 days of azithromycin enough?

ABSTRACT

ED clinicians typically discharge patients on 5-day regimens of azithromycin and corticosteroids after an acute COPD exacerbation. This article discusses various studies that evaluated chronic azithromycin therapy to prevent exacerbations in patients with COPD. Although ED clinicians typically do not prescribe chronic medications, they can provide patient-centered care and determine a patient's follow-up to see if chronic azithromycin is needed.