Home spirometry as early detector of azithromycin refractory bronchiolitis obliterans syndrome in lung transplant recipients.

Abstract

BACKGROUND:

To evaluate the utility of home spirometry (HS) versus office spirometry (OS) in assessing treatment response to azithromycin in bronchiolitis obliterans syndrome (BOS).

METHODS:

239 Lung transplant recipients were retrospectively studied. ΔFEV1 ± 10% from FEV1 at azithromycin initiation for ≥7 consecutive days in HS or ≥2 measures in OS were taken as cut-off for response or progression.

RESULTS:

Based upon HS, 161/239 (67%) patients were progressive despite macrolide, 19 of who exhibited transient improvement in FEV1 (11%). Time to progression was 29 (13-96) days earlier with HS than in OS. Forty-six (19%) recipients responded in HS after median 81 (22-343) days, whilst 22% remained stable. Concordance in azithromycin treatment response between OS and HS was observed in 210 of 239 patients (88%). Response or stabilization conferred significant improvement in survival (p = 0.005). Transient azithromycin responders demonstrated improved survival when compared to azithromycin refractory patients (p = 0.034).

CONCLUSIONS:

HS identified azithromycin refractory patients significantly earlier than OS, possibly facilitating aggressive treatment escalation that may improve long-term outcome. Treatment response to azithromycin should be assessed 4 weeks after initiation. Responders demonstrated best survival, with even transient response conferring benefit. Macrolide-refractory BOS carried the worst prognosis.

• Authors: Claudia de Wall, Dettmer Sabine, Warnecke Gregor, Greer Mark, Haverich Axel, Fuehner Thomas, Welte Tobias, Gottlieb Jens
• Journal: Respiratory medicine (Respir Med) Vol. 108 Issue 2 Pg. 405-12 (Feb 2014) ISSN: 1532-3064 [Electronic] England
• PMID: 24445061 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Elsevier Ltd. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Azithromycin

Topics

• Adult
• Anti-Bacterial Agents (therapeutic use)
• Azithromycin (therapeutic use)
• Bronchiolitis Obliterans (drug therapy, mortality, physiopathology)
• Disease Progression
• Drug Resistance, Bacterial
• Early Diagnosis
• Female
• Forced Expiratory Volume (drug effects)
• Home Care Services
• Humans
• Lung Transplantation
• Male
• Middle Aged
• Retrospective Studies
• Spirometry (methods)
• Survival Analysis
• Treatment Outcome