We did not exclude participants on the basis of smoking or on the basis of an element of coexisting fixed obstruction, since these characteristics are present in about half of adult asthma patients in the community . in four says K145 hydrochloride and one Canadian province. Participants: Adults with stable, persistent asthma. Interventions: Azithromycin (six weekly doses) or identical matching placebo, plus usual community care. Outcome Steps: Juniper Asthma Quality of Life Questionnaire (Juniper AQLQ), symptom, and medication changes from baseline (pretreatment) to 3 mo posttreatment (follow-up); IgG and IgA antibodies at baseline and follow-up. Results: Juniper AQLQ improved by 0.25 (95% confidence interval; ?0.3, 0.8) models, overall asthma symptoms improved by 0.68 (0.1, 1.3) models, and rescue inhaler use decreased by 0.59 (?0.5, 1.6) daily administrations in azithromycin-treated compared to placebo-treated participants. Baseline IgA antibodies were positively associated with worsening overall K145 hydrochloride asthma symptoms at follow-up (= 0.04), but IgG was not (= 0.63). Overall asthma symptom improvement attributable to azithromycin was 28% in high IgA participants versus 12% in low IgA participants (for conversation = 0.27). Conclusions: Azithromycin did not improve Juniper AQLQ but appeared to improve overall asthma symptoms. Larger community-based trials of antichlamydial antibiotics for asthma are warranted. Editorial Commentary Background: is usually a common bacterium thought to be responsible for a substantial proportion of community-acquired pneumonia and bronchitis infections. There is some observational evidence associating chronic contamination with more severe symptoms in people with asthma. However, there are very little data from clinical trials determining whether treatment with antibiotics active against has an effect on the control of asthma. What this trial shows: In this trial, the researchers randomized 45 adults who were being treated for asthma in primary care to receive either azithromycin (an antibiotic active against is usually a ubiquitous intracellular human pathogen that is reported to cause approximately 10% of community-acquired pneumonia and 5% of acute bronchitis . Chlamydial infections are characterized by persistence and immunopathologic damage to host target tissues, including the lung. contamination has been associated with acute asthmatic bronchitis [2,3], bronchial hyperreactivity [4,5], new-onset asthma , chronic asthma [3,5], infectious asthma (asthma that first became symptomatic after an acute lower respiratory tract illness) , and asthma severity [8C10]. ChlamydiaCasthma associations raise the question whether antibiotic treatment can improve asthma long term, but clinical trial evidence for persisting antichlamydial antibiotic effects on asthma is limited. An open-label before-after trial in 48 adults with stable, persistent asthma Alpl reported that over half of participants who were treated with 3C9 wk of antibiotics, consisting mostly of azithromycin, had major lasting clinical improvement or complete remission of asthma symptoms . A preliminary report of K145 hydrochloride a randomized trial of 10 d of telithromycin (a ketolide antibiotic with antichlamydial activity) in 278 adults with acute asthma exacerbations documented significant positive effects at the end of treatment  but did not report whether the K145 hydrochloride improvement persisted. The primary objectives of our pilot study were to investigate (1) the feasibility of performing an asthma clinical trial in practice settings and (2) the power of an interactive voice-response (IVR) telephone system to collect asthma outcome data. The primary feasibility results have been published elsewhere . In summary, we concluded that physician recruiting, randomizing, and completing a representative sample of adult asthma patients was feasible, but that power of IVR in primary care research required further study, primarily because of underreporting. For example, 39 (87%) of 45 participants attended the follow-up clinical visit, 36 (80%) provided complete quality-of-life data, and 33 (73%) provided adequate asthma symptom and rescue bronchodilator medication data. The secondary objectives were to investigate (1) whether azithromycin treatment would affect any asthma outcome steps and (2) whether serology would be related to outcomes. This report presents the secondary results. METHODS Participants We performed a community-based, multisite, randomized, allocation-concealed, blinded (patient, physician, data collector, data analyst), placebo-controlled trial in 45 adults with stable, persistent asthma recruited from primary care practices, an emergency room, and a community-based asthma research center. Potentially eligible patients were those aged 18 or older with a diagnosis of current asthma (variable symptoms of wheeze, chest tightness, cough, or shortness of breath triggered by a variety of stimuli) that was persistent, stable, and present for more than 3 mo prior to enrollment . Stability was assessed during a 2C3 wk run-in period during which eligible patients remained in the same severity class (moderate, moderate, or severe) and had no acute exacerbations. Documented objective evidence for reversible airway obstruction, either spontaneously or after treatment, was also required prior to randomization, either FEV1 change of.
We did not exclude participants on the basis of smoking or on the basis of an element of coexisting fixed obstruction, since these characteristics are present in about half of adult asthma patients in the community