title: The role of atypical infections and macrolide therapy in patients with asthma.
abstract: For many years, the clinical benefit of macrolide use has been recognized in specific groups of patients with pulmonary disease. Dramatic improvement in survival of patients with diffuse panbronchiolitis is the most striking example of successful macrolide use as well as treatment of community acquired pneumonia caused by the atypical bacteria Mycoplasma, Chlamydophila, and Legionella. There also has been documentation of reduction in the exacerbation rate and of improvement in quality of life in patients with cystic fibrosis, bronchiectasis, chronic obstructive pulmonary disease, and reduction in post-lung transplantation bronchiolitis frequency. There has long been an interest in treating patients with severe asthma by using macrolides, but research results have not shown consistent clinical benefit in their use in the "general" population of patients with severe asthma. Rather, the successful use of macrolides seems to be in those patients with either documented Mycoplasma or Chlamydophila infection, or noneosinophilic asthma. Patients with neutrophil predominant phenotype severe asthma tend to show a decline in exacerbation rate, improved peak expiratory flows, and improved quality of life when treated with macrolides. This article will review the use of macrolides in the treatment of asthma.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, National Jewish Health, Denver, Colo; Department of Medicine, National Jewish Health, Denver, Colo. Electronic address: RollinsD@njhealth.org.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Rollins
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, National Jewish Health, Denver, Colo; Department of Medicine, National Jewish Health, Denver, Colo.
authors.forename: James T
authors.initials: JT
authors.lastname: Good
authors.affiliation: Department of Medicine, National Jewish Health, Denver, Colo.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Martin
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D001424:Bacterial Infections / Q000188:drug therapy*; D024881:Drug Resistance, Bacterial; D006801:Humans; D018942:Macrolides / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D018942:Macrolides
keywords: Airway evaluation; Allergy; Antibiotics and asthma; Asthma; Asthma phenotype; Cytokine; Macrolides; Mycoplasma; Viral infections