title: Lung transplantation: the role of azithromycin in the management of patients with bronchiolitis obliterans syndrome.
abstract: Bronchiolitis obliterans syndrome (BOS) is the leading cause of death in lung transplant recipients (LTR). BOS is thought to result from chronic immunologic/inflammatory insults leading to peri-bronchiolar leukocyte infiltration, with a subsequent exuberant tissue re-modelling and fibro-obliteration of the luminal space of the allograft airways. Diagnosis is based on functional criteria and severity is graded on the degree of Forced Expiratory Volume in 1 second (FEV1) impairment. Current strategies to improve pulmonary function once BOS is established have demonstrated little or no impact on disease progression and re-transplantation remains the only therapeutic option. Among the alternative treatments which have been attempted in the last few years, long-term azithromycin treatment seems to be the most promising therapeutic device for BOS treatment. Azithromycin is a macrolide antibiotic, endowed with a broad spectrum of anti-inflammatory/immunomodulatory activities. Long-term oral azithromycin therapy can significantly improve FEV1 in about 42% of patients with established BOS. Moreover, reduced neutrophilia, chemokine release and bacterial exacerbations have been demonstrated. These observations suggest that the drug can down-regulate pulmonary inflammation, even if the precise underlying mechanisms still need to be determined.
authors.affiliation: Department of Hematological, Pneumological and Cardiovascular Sciences - Section of Pneumology - University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. a.fietta@smatteo.pv.it
authors.forename: A M
authors.initials: AM
authors.lastname: Fietta
authors.forename: F
authors.initials: F
authors.lastname: Meloni
mesh_terms: D017963:Azithromycin / Q000008:administration & dosage / Q000378:metabolism / Q000627:therapeutic use*; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D013577:Syndrome
chemical_list: D017963:Azithromycin