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22-04-2010 | Respiratory | Article

Long-term azithromycin treatment may benefit COPD patients with a tracheostomy


Free abstract

MedWire News: Long-term treatment with the macrolide antibiotic azithromycin reduces exacerbations and hospitalization rates and improves quality of life in chronic obstructive pulmonary disease (COPD) patients with a tracheostomy, results from a preliminary study suggest.

“The use of tracheostomy is a well known indication for patients with end-stage COPD who require airway access for secretion removal, who need to be weaned from mechanical ventilation during an exacerbation or who become chronically ventilator-dependent,” explain Francesco Blasi (University of Milan, Italy) and team.

However, they add that COPD patients with a tracheostomy are at high risk for exacerbations and hospitalization, possibly due to bacterial colonization of the airways causing persistent inflammation.

To investigate whether long-term treatment with azithromycin may benefit such patients, the researchers studied 22 COPD patients, aged an average of 72.5 years, who had undergone a tracheostomy. Of these, 11 were assigned to receive azithromycin 500 mg 3 days per week for 6 months and the remaining 11 were assigned to usual care.

There were no significant differences in baseline characteristics between the two groups, the researchers note in the journal Pulmonary Pharmacology and Therapeutics.

The researchers found that patients receiving azithromycin had experienced a significantly lower cumulative number of exacerbations after 3 months of treatment than those receiving usual care, at two versus 12 exacerbations.

After adjustment for potential confounding factors, loss to follow-up, and death, patients in the standard care group were 5.41 times more likely to experience an exacerbation during the 12-month study period than those in the azithromycin group.

Patients in the azithromycin group also had a significantly lower number of hospitalizations after 3 months of treatment than those in the usual care group, at zero versus four hospitalizations.

Overall, patients in the standard care group were 2.64 times more likely to be hospitalized during the study period than those in the azithromycin group, after adjustment.

Quality of life, as measured using the Maugeri Respiratory Failure questionnaire, also improved significantly over the course of the study in patients receiving azithromycin, but remained unchanged in patients receiving usual care.

Blasi and team conclude: “In our pilot study, long-term azithromycin treatment seems to be safe and effective in severe COPD outpatients with tracheostomy in reducing exacerbations, hospitalizations, antibiotic and steroid use, as well as in improving quality of life.”

They add: “If our data [are] confirmed in future randomized controlled trials, macrolide treatment could have a role in a long-term treatment of patients with COPD and tracheostomy.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Mark Cowen

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