title: Evidence of improved small airways function after azithromycin treatment in diffuse panbronchiolitis.
abstract: A 67-year-old never-smoker was diagnosed with diffuse panbronchiolitis (DPB) and was started on 250 mg azithromycin twice weekly. Over a 16-month observation period, lung function was assessed monthly, including a dedicated small airways test, the multiple breath nitrogen washout (MBW) with indices S(cond) and S(acin) of ventilation heterogeneity at the level of the conductive and acinar air spaces, respectively. Baseline measurements indicated moderate airway obstruction, air trapping and considerable dysfunction of the small airways around the acinar entrance. Treatment resulted in excellent symptomatic improvement paralleled by marked improvements in FEV(1), FVC, RV/TLC, S(cond) and S(acin); by contrast, there were no consistent changes in FEF(75) or TL(CO). While improvements were such that S(cond) fell within normal limits after 5 months, S(acin) remained abnormal even after 16 months of treatment. This suggests a distinct acinar structural abnormality in DPB that cannot be reversed by azithromycin.
authors: Respiratory Division, University Hospital UZ Brussel, Brussels, Belgium. shane.hanon@uzbrussel.be
authors: Shane
authors: S
authors: Hanon
authors: Sylvia
authors: S
authors: Verbanck
authors: Daniel
authors: D
authors: Schuermans
authors: Bram
authors: B
authors: Vanden Berghe
authors: Eef
authors: E
authors: Vanderhelst
authors: Walter
authors: W
authors: Vincken
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D001944:Breath Tests; D001988:Bronchiolitis / Q000188:drug therapy*; D006192:Haemophilus Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D009584:Nitrogen; D013147:Spirometry; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin; D009584:Nitrogen