Effect of 6 Months of Erythromycin Treatment on Inflammatory Cells in Induced Sputum and Exacerbations in Chronic Obstructive Pulmonary Disease

• Published in: Respiration Vol. 80; no. 6; pp. 445 - 452
• Main Authors: He, Zhi-Yi, Ou, Li-Mei, Zhang, Jian-Quan, Bai, Jing, Liu, Guang-Nan, Li, Mei-Hua, Deng, Jing-Min, MacNee, William, Zhong, Xiao-Ning
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 01.01.2010; S. Karger AG
• Subjects: Aged; Allergies; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Cells; Chronic obstructive pulmonary disease; Chronic obstructive pulmonary disease, asthma; Clinical Investigations; Double-Blind Method; Drug therapy; Erythromycin - administration & dosage; Erythromycin - adverse effects; Female; Humans; Inflammatory diseases; Leukocyte Count; Leukocyte Elastase - analysis; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Pneumology; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - immunology; Quality of Life; Sputum - cytology; Sputum - drug effects; Sputum - immunology; Sputum - microbiology; Treatment Outcome; Exacerbation, respiratory; Chronic obstructive pulmonary disease; Airway inflammation; Anti-inflammatory effects; Macrolides; Neutrophils; Lung disease; Respiratory disease; Antiinflammatory agent; Granulocyte; Inflammation; Erythromycin; Macrolide; Antibiotic; Treatment; Sputum; Bronchus disease; Inflammatory cell; Neutrophil; Antibacterial agent; Pneumology
• DOI: 10.1159/000321374
• ISSN: 0025-7931; 1423-0356

Background: Chronic obstructive pulmonary disease (COPD) is characterized by airway inflammation and is associated with acute exacerbations. Macrolide antibiotics have been shown to exhibit anti-inflammatory effects in some chronic airway inflammatory diseases. Objective: The aim of this study was to assess the effect of treatment with erythromycin on airway inflammation and health outcome in COPD patients. Methods: We conducted a randomized, placebo-controlled, double-blind trial of erythromycin for a period of 6 months. Thirty-six COPD patients were randomized to treatment with oral erythromycin (125 mg, three times/day) or placebo. The primary outcomes were neutrophil number in sputum and exacerbations. Results: Thirty-one patients completed the study. At the end of treatment, neutrophil counts in the sputum were significantly decreased in the group treated with erythromycin compared with placebo-treated patients (p = 0.005). Total cells in the sputum and neutrophil elastase in sputum supernatant were also significantly decreased in those treated with erythromycin compared with the placebo group (p = 0.021 and p = 0.024, respectively). The mean exacerbation rate was lower in the erythromycin group than in the placebo group (relative risk = 0.554, p = 0.042). Kaplan-Meier survival analysis showed that erythromycin significantly delayed the time to the first COPD exacerbation compared with placebo (p = 0.032). Conclusions: Erythromycin treatment in COPD patients can reduce airway inflammation and decrease exacerbations and may therefore be useful in the management of COPD.