Applying lessons learned in the treatment of diffuse panbronchiolitis to other chronic inflammatory diseases.
In addition to having antibacterial effects, macrolides modulate inflammatory responses. Their effectiveness in treating chronic inflammatory airway disease is well documented in patients with diffuse panbronchiolitis (DPB), a chronic condition characterized by inflammation of the airways that, if left untreated, progressively leads to respiratory failure and death. Long-term treatment with certain macrolides has dramatically improved the survival of patients with DPB. The mechanisms of action for the anti-inflammatory properties of macrolides are still being studied. The effects of macrolides on inflammation include decreasing chemotaxis of neutrophils to the respiratory tract and inhibiting the expression of adhesion molecules, with decreased infiltration of neutrophils into the respiratory epithelium. Macrolides also inhibit expression of transcription factors and formation of proinflammatory cytokines, and directly and indirectly block mucus secretion. Even with long-term use, macrolides are safe and well tolerated. The effectiveness of macrolides for treating DPB has led to interest in their use in treating other chronic inflammatory airway diseases. As discussed in this article, because of the similarities between the clinical presentation of cystic fibrosis and chronic bronchitis and DPB, the effects of macrolides in patients with these diseases are currently being studied with particular interest.
Kudoh
Shoji
S
Nippon Medical School, Tokyo, Japan.
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001988:Bronchiolitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D001991:Bronchitis / Q000150:complications / Q000188:drug therapy; D002908:Chronic Disease; D003550:Cystic Fibrosis / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007249:Inflammation / Q000188:drug therapy* / Q000209:etiology; D018942:Macrolides / Q000627:therapeutic use*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D018942:Macrolides