Macrolide Antibiotics in Asthma Management
Summary
Macrolide antibiotics such as azithromycin and clarithromycin have emerged as adjunctive therapies in asthma, combining antimicrobial action with anti-inflammatory, immunomodulatory and pro-repair effects. Beyond their inhibition of bacterial protein synthesis, macrolides attenuate neutrophilic inflammation, reduce mucus hypersecretion and modulate key signalling pathways, including NF-κB. Clinical investigations have explored long-term, low-dose regimens aimed at decreasing exacerbation frequency, reducing corticosteroid dependence and improving quality of life, especially in severe or treatment-resistant phenotypes. Proposed mechanisms include suppression of pro-inflammatory cytokines, inhibition of airway smooth muscle proliferation and enhancement of epithelial barrier integrity. Patient stratification by inflammatory phenotype, microbial colonisation and concurrent biologic therapy influences therapeutic response. Safety considerations focus on potential cardiac effects and the emergence of antibiotic resistance. Although guidelines do not yet universally endorse macrolides for asthma, accumulating evidence supports their targeted use in selected patients to mitigate exacerbations and reduce healthcare utilisation.
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Macrolide Antibiotics in Asthma Management publication trend
The graph below shows the total number of articles in macrolide antibiotics in asthma management across all publications each year (not limited to Nature Index journals).
Technical terms
Exacerbation: A worsening of asthma symptoms necessitating additional treatment or hospital admission.
Eosinophilic asthma: A subtype characterised by elevated eosinophil counts in airway tissues and sputum.
Biologics: Monoclonal antibody therapies targeting specific inflammatory pathways in asthma, such as anti-IL-5 or anti-IgE agents.
Histone H3K27me3: Trimethylation of the 27th lysine residue on histone H3, an epigenetic mark linked to gene repression.
EZH2: A histone methyltransferase enzyme responsible for catalysing H3K27 trimethylation, influencing chromatin structure and gene expression.
References
- Effects of azithromycin in severe eosinophilic asthma with concomitant monoclonal antibody treatment. Thorax (2024).
- Azithromycin attenuates wheezing after pulmonary inflammation through inhibiting histone H3K27me3 hypermethylation mediated by EZH2. Clinical Epigenetics (2023).
- Long-term, low-dose macrolide antibiotic treatment in pediatric chronic airway diseases. Pediatric Research (2021).
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