Long-term macrolide antibiotic therapy in the treatment of chronic small airway disease clinically mimicking diffuse panbronchiolitis.
OBJECTIVE
In the current studies, we investigated the clinical effects of long-term macrolide antibiotic therapy for patients with chronic small airway disease (CAD) that clinically and radiologically mimics but is pathologically distinct from diffuse panbronchiolitis (DPB).


METHODS
Twenty-one Japanese patients were selected on the basis of clinical criteria for DPB and were categorized as DPB or CAD following histological evaluation of surgical lung biopsies. All patients received long-term macrolide therapy, and therapeutic results were compared for the DPB and CAD groups.


RESULTS
Clinical, laboratory, radiological, and bacterial features, as well as neutrophilia in bronchoalveolar lavage fluid were strikingly similar in both groups. Long-term treatment with macrolides improved the clinical symptoms and PaO(2) in both groups. There was a significant improvement in forced expiratory volume in one second (FEV(1)), vital capacity (VC), and %VC in patients with DPB but not in patients with CAD. Neutrophilia in bronchoalveolar lavage fluid was also reduced following therapy in DPB patients but was refractory in CAD patients.


CONCLUSIONS
Based on the different responses to macrolides, CAD might be associated with conditions distinct from those of DPB. Nevertheless, low-dose macrolide therapy may be applied in CAD to achieve clinical improvement, such as in respiratory symptoms and PaO(2).
Kadota
Jun-ichi
J
Division of Pathogenesis and Disease Control, Department of Infectious Diseases, Oita University Faculty of Medicine, 1-1 Hasama, Oita 879-5593.
Mukae
Hiroshi
H
Mizunoe
Syunji
S
Kishi
Kenji
K
Tokimatsu
Issei
I
Nagai
Hiroyuki
H
Tomono
Kazunori
K
Kohno
Shigeru
S
Nasu
Masaru
M
D000328:Adult; D001706:Biopsy; D001987:Bronchiectasis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D001988:Bronchiolitis / Q000175:diagnosis*; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D001999:Bronchoscopy; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D007958:Leukocyte Count; D008168:Lung / Q000473:pathology; D018942:Macrolides / Q000627:therapeutic use*; D008297:Male; D009504:Neutrophils; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014797:Vital Capacity / Q000502:physiology
D018942:Macrolides