Intervention Review

Macrolides for chronic asthma

  1. Luca Richeldi1,*,
  2. Giovanni Ferrara2,
  3. Leonardo Fabbri3,
  4. Toby J Lasserson4,
  5. Peter G Gibson5

Editorial Group: Cochrane Airways Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 20 MAY 2007

DOI: 10.1002/14651858.CD002997.pub3

Database Title

Additional Information

How to Cite

Richeldi L, Ferrara G, Fabbri L, Lasserson TJ, Gibson PG. Macrolides for chronic asthma. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD002997. DOI: 10.1002/14651858.CD002997.pub3.

Author Information

  1. 1

    Policlinico di Modena, Divisione di Pneumologia, Modena, Italy

  2. 2

    Department of Internal Medicine, Unversity of Perugia, Section of Respiratory Diseases, Terni , Italy

  3. 3

    Universita degli Studi di Modena e Reggio Emilia, Clinica di Malattie dell'Apparato Respiratorio, Modena, Italy

  4. 4

    St George's, University of London, Community Health Sciences, London, UK

  5. 5

    John Hunter Hospital, Department of Respiratory and Sleep Medicine, Hunter Mail Centre, NSW, Australia

*Luca Richeldi, Divisione di Pneumologia, Policlinico di Modena, Via del Pozzo, 71, Modena, 41100, Italy. richeldi.luca@unimo.it.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 OCT 2008

SEARCH

ARTICLE TOOLS

View Full Article (HTML) Summary (56K)Standard (375K)Full (443K)
 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Asthma is a chronic disease of the airways in which inflammation of the respiratory mucosa plays a crucial role. The mechanisms responsible for the maintaining of this inflammatory response are only partially known and there is evidence that a role could be paid by chronic infection by intracellular pathogens (such as Chlamydia pneumoniae). Macrolides are antibiotics with both antimicrobic and antiinflammatory activities and thus their use in asthmatic patients could lead to reduction of the airways inflammation and therefore improvement of symptoms and pulmonary function.

Objectives

To determine whether macrolides are effective in the management of patients with chronic asthma.

Search methods

We searched the Cochrane Airways Group Specialised Register of trials up to May 2007. This was also supplemented by manually searching bibliographies of previously published reviews, conference proceedings, and contacting study authors. All languages were included in the search.

Selection criteria

Randomised, controlled clinical trials involving both children and adult patients with chronic asthma treated with macrolides for more than 4 weeks, versus placebo.

Data collection and analysis

Two reviewers independently examined all identified articles. The full text of any potentially relevant article was reviewed independently by two reviewers.

Main results

Seven studies recruiting a total of 416 participants met the inclusion criteria. The quality of reporting of study methodology was generally low. We assembled findings from studies comparing macrolide treatment for at least 4 weeks in adult and pediatric patients treated for chronic asthma. Four studies showed a positive effect on symptoms of macrolides in different types of asthmatic patients. There were limited data available for meta-analysis. There was no significant difference in FEV1 for either parallel or crossover trials. However, there were significant differences in eosinophilic inflammation and symptoms. One large parallel group trial reported significant differences in peak flow but these differences abated within six months of treatment.

Authors' conclusions

Considering the small number of patients studied, there is insufficient evidence to support or to refute the use of macrolides in patients with chronic asthma. Further studies are needed in particular to clarify the potential role of macrolides in some subgroups of asthmatics such as those with evidence of chronic bacterial infection.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Macrolides for chronic asthma

Asthma is a chronic inflammatory disorder of the airways. Macrolide antibiotics are potential antiinflammatory drugs that may be of use in asthma. This systematic review examined several randomised controlled trials of macrolide antibiotic therapy in asthma. While the results support an antiinflammatory effect of this class of drugs in asthma, there were no clear benefits to participants with asthma. This may have been because the study design was not optimal. More research is needed to examine the role of macrolides in asthma therapy.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以Macrolides治療慢性氣喘

氣喘是一種呼吸道粘膜發炎扮演重要角色的慢性疾病。導致發炎反應持續進行的機制只有部分知道，並有證據顯示細胞內病原體(如Chlamydia pneumoniae)可能有些角色。Macrolides是同時具有抗微生物及抗發炎活性的抗生素，故它們用於氣喘病人可減少氣道發炎而能改善症狀及肺功能。

目標

確認以macrolides治療慢性氣喘病人是否有效。

搜尋策略

我們搜尋Cochrane Airways Group Specialised Register of trials至2007年5月。亦採用人工搜尋已刊載回顧性文章的參考資料、會議刊物以及聯繫研究的作者。所有語文均包含於搜尋中。

選擇標準

納入兒童及成年慢性氣喘患者使用macrolides治療4週以上並與安慰劑比較的隨機對照臨床試驗。

資料收集與分析

兩名審查者獨立地審查所有找到的文章。任何可能相關的文章之全文均由兩名審查者獨立地審查。

主要結論

有七項共納入416名參與者的研究符合納入標準。研究方法學的品質在報告中看來普遍不佳。我們在探討成年及兒科病人使用macrolide治療慢性氣喘至少4週的研究中收集資料。有四項研究顯示macrolides對不同類型氣喘患者的症狀具有正向效應。取得的數據有限而不足以進行綜合分析。無論是平行或交叉試驗在FEV1均無顯著差異。然而，在嗜伊紅性白血球性發炎及症狀則有顯著差異。一項大規模的平行組試驗報告在頂?氣流有顯著差異，但此等差異在治療6個月內則會減弱。

作者結論

考量被研究病人的數目不多，沒有足夠證據支持或駁斥慢性氣喘患者使用macrolides。需要有進一步的研究用以釐清macrolides在某些氣喘患者次族群(如證明有慢性細菌性感染的患者)的可能角色。

翻譯人

本摘要由中國醫藥大學附設醫院陳祖裕翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

氣喘是一種氣道慢性發炎性疾病。Macrolide類抗生素是具有抗發炎潛力的藥物而可能對氣喘有用。本系統性回顧檢視數項以macrolide類抗生素治療氣喘的隨機對照試驗。所得結果一方面支持這類藥物對氣喘具有抗發炎效應，另一方面顯示對氣喘參與者無明確效益。這可能是因為研究設計未達理想。需要有更多的研究檢視macrolides在治療氣喘的角色。

View Full Article (HTML) Summary (56K)Standard (375K)Full (443K)