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KMID : 1141720220100020065
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폐쇄성폐질환
2022 Volume.10 No. 2 p.65 ~ p.70
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When should we consider the use of macrolides in asthma patients?
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Park Han-Ki
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Abstract
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Macrolide antibiotics, which reversibly bind to ribosomes, are commonly used for treating respiratory infections by inhibiting RNA-dependent protein synthesis. They are characterized by a macrocyclic lactone ring, which is either 14- [erythromycin, clarithromycin and roxithromycin], 15- [azithromycin], or 16-membered (spiramycin, josamycin, and midecamycin). Macrolides, especially azithromycin, are known to have not only antibacterial but also immunomodulatory effects. Numerous in vivo and in vitro experiments have provided evidence that macrolides modulate neutrophil, eosinophil, and lymphocyte activity. Therefore, they can be used to treat chronic inflammatory diseases, including severe asthma, bronchiectasis, COPD, cystic fibrosis, and chronic rhinosinusitis. A recent double-blind randomized controlled trial demonstrated that azithromycin is particularly effective in reducing asthma exacerbations. Thus, the GINA guideline recommends considering the addition of azithromycin in step 5 of adult asthma that is not controlled even with high-dose ICS/LABA. However, the long term use of macrolides requires the emergence of resistant bacterial infection to be taken into consideration. In addition, gastrointestinal side effects, such as diarrhea, are common. Therefore, the long term use of macrolides requires careful selection. Herein, the mechanism of immunomodulation of macrolides, their indications, and precautions in patients with asthma have been discussed.
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KEYWORD
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Asthma, Macrolide, Anti-Inflammatory Agents, Exacerbation
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