Long-term azithromycin therapy in patients with severe COPD and repeated exacerbations

Abstract

Background: The aim of this study was to determine whether long-term intermittent azithromycin therapy reduces the frequency of exacerbation in severe chronic obstructive pulmonary disease (COPD). Methods: We retrospectively investigated the clinical benefts of long-term azithromycin (500 mg orally three times per week) over 12 months in patients with severe COPD and a minimum of four acute exacerbations (AECOPD) per year or chronic bronchial colonization by Pseudomonas aeruginosa, comparing the number of AECOPD, hospitalizations due to respiratory disease, days of hospital stay, and bacterial infections during azithromycin treatment and in the year prior to this therapy. Results: Twenty patients who completed the 12-month treatment period were analyzed. No clinically signifcant adverse events were observed during azithromycin treatment. Compared with baseline data, azithromycin therapy signifcantly reduced the number of AECOPD (2.8 ± 2.5 versus 6.8 ± 2.8, P, 0.001), hospitalizations (1.4 ± 1.5 versus 3.6 ± 1.4, P, 0.001), and cumulative annual days of hospital stay (25 ± 32.2 versus 43.7 ± 21.4, P = 0.01). The improvement was particularly signifcant in patients with exacerbations caused by common potentially pathogenic microorganisms, who had 70% fewer AECOPD and hospitalizations. Patients colonized by P. aeruginosa had reductions of 43% in AECOPD and 47% in hospitalizations. Conclusion: Long-term azithromycin is well tolerated and associated with signifcant reductions in AECOPD, hospitalizations, and length of hospital stay in patients with severe COPD. © 2011 Pomares et al, publisher and licensee Dove Medical Press Ltd.