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Cuevas E, Huertas D, Montón C, Marin A, Carrera-Salinas A, Pomares X, García-Nuñez M, Martí S, Santos S. Systemic and functional effects of continuous azithromycin treatment in patients with severe chronic obstructive pulmonary disease and frequent exacerbations. Front Med (Lausanne) 2023; 10:1229463. [PMID: 37554497 PMCID: PMC10406447 DOI: 10.3389/fmed.2023.1229463] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/06/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Continuous treatment with azithromycin may lead to fewer acute exacerbations of chronic obstructive pulmonary disease (AECOPD), but little is known of its impact on systemic and functional outcomes in real-life settings. METHODS This was a multicenter prospective observational study of patients with severe COPD who started treatment with azithromycin. Tests were compared at baseline and after 3 and 12 months of treatment. These included lung function tests, a 6-min walking test (6MWT), and enzyme-linked immunosorbent assays of serum and sputum markers, such as interleukins (IL-6, IL-8, IL-13, IL-5), tumor necrosis factor receptor 2 (TNFR2), and inflammatory markers. Incidence rate ratios (IRR) and their 95% confidence intervals (95% CI) are reported. RESULTS Of the 478 eligible patients, the 42 who started azithromycin experienced reductions in AECOPDs (IRR, 0.34; 95% CI, 0.26-0.45) and hospitalizations (IRR, 0.39; 95% CI, 0.28-0.49). Treatment was also associated with significant improvement in the partial arterial pressure of oxygen (9.2 mmHg, 95% CI 1.4-16.9) at 12 months. While TNFR2 was reduced significantly in both serum and sputum samples, IL-13 and IL-6 were only significantly reduced in serum samples. Moreover, an elevated serum and sputum IL-8 level significantly predicted good clinical response to treatment. CONCLUSION Continuous azithromycin treatment in a cohort of patients with severe COPD and frequent exacerbations can significantly reduce the number and severity of exacerbations and improve gas exchange. Treatment changes the pattern of microorganism isolates and decreases the inflammatory response. Of note, IL-8 may have utility as a predictor of clinical response to azithromycin treatment.
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Affiliation(s)
- Ester Cuevas
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge, Institut d’Investigacio Biomedica de Bellvitge – IDIBELL, Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Daniel Huertas
- Department of Respiratory Medicine, Consorci Sanitari Alt Penedès Garraf, Barcelona, Spain
| | - Concepción Montón
- Department of Respiratory Medicine, Hospital de Sabadell, Institut Universitari Parc Taulí-UAB, Sabadell, Spain
| | - Alicia Marin
- Research Network for Respiratory Diseases (CIBERes), ISCIII, Madrid, Spain
- Department of Respiratory Medicine, Hospital Germans Trias i Pujol, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol – IGTP, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Anna Carrera-Salinas
- Department of Microbiology, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Xavier Pomares
- Department of Respiratory Medicine, Hospital de Sabadell, Institut Universitari Parc Taulí-UAB, Sabadell, Spain
| | - Marian García-Nuñez
- Department of Respiratory Medicine, Hospital de Sabadell, Institut Universitari Parc Taulí-UAB, Sabadell, Spain
- Research Network for Respiratory Diseases (CIBERes), ISCIII, Madrid, Spain
| | - Sara Martí
- Research Network for Respiratory Diseases (CIBERes), ISCIII, Madrid, Spain
- Department of Microbiology, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Salud Santos
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge, Institut d’Investigacio Biomedica de Bellvitge – IDIBELL, Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERes), ISCIII, Madrid, Spain
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