title: Effect of 6 months of erythromycin treatment on inflammatory cells in induced sputum and exacerbations in chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is characterized by airway inflammation and is associated with acute exacerbations. Macrolide antibiotics have been shown to exhibit anti-inflammatory effects in some chronic airway inflammatory diseases.
  
  
  OBJECTIVE
  The aim of this study was to assess the effect of treatment with erythromycin on airway inflammation and health outcome in COPD patients.
  
  
  METHODS
  We conducted a randomized, placebo-controlled, double-blind trial of erythromycin for a period of 6 months. Thirty-six COPD patients were randomized to treatment with oral erythromycin (125 mg, three times/day) or placebo. The primary outcomes were neutrophil number in sputum and exacerbations.
  
  
  RESULTS
  Thirty-one patients completed the study. At the end of treatment, neutrophil counts in the sputum were significantly decreased in the group treated with erythromycin compared with placebo-treated patients (p = 0.005). Total cells in the sputum and neutrophil elastase in sputum supernatant were also significantly decreased in those treated with erythromycin compared with the placebo group (p = 0.021 and p = 0.024, respectively). The mean exacerbation rate was lower in the erythromycin group than in the placebo group (relative risk = 0.554, p = 0.042). Kaplan-Meier survival analysis showed that erythromycin significantly delayed the time to the first COPD exacerbation compared with placebo (p = 0.032).
  
  
  CONCLUSIONS
  Erythromycin treatment in COPD patients can reduce airway inflammation and decrease exacerbations and may therefore be useful in the management of COPD.
authors.affiliation: Respiratory Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, China.
authors.forename: Zhi-Yi
authors.initials: ZY
authors.lastname: He
authors.forename: Li-Mei
authors.initials: LM
authors.lastname: Ou
authors.forename: Jian-Quan
authors.initials: JQ
authors.lastname: Zhang
authors.forename: Jing
authors.initials: J
authors.lastname: Bai
authors.forename: Guang-Nan
authors.initials: GN
authors.lastname: Liu
authors.forename: Mei-Hua
authors.initials: MH
authors.lastname: Li
authors.forename: Jing-Min
authors.initials: JM
authors.lastname: Deng
authors.forename: William
authors.initials: W
authors.lastname: MacNee
authors.forename: Xiao-Ning
authors.initials: XN
authors.lastname: Zhong
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D004917:Erythromycin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D019272:Leukocyte Elastase / Q000032:analysis; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000276:immunology; D011788:Quality of Life; D013183:Sputum / Q000166:cytology / Q000187:drug effects* / Q000276:immunology / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004917:Erythromycin; D019272:Leukocyte Elastase