For many years, the clinical benefit of
macrolide use has been recognized in specific groups of patients with
pulmonary disease. Dramatic improvement in survival of patients with
diffuse panbronchiolitis is the most striking example of successful
macrolide use as well as treatment of community acquired
pneumonia caused by the atypical bacteria Mycoplasma, Chlamydophila, and Legionella. There also has been documentation of reduction in the exacerbation rate and of improvement in quality of life in patients with
cystic fibrosis,
bronchiectasis,
chronic obstructive pulmonary disease, and reduction in post-
lung transplantation bronchiolitis frequency. There has long been an interest in treating patients with severe
asthma by using
macrolides, but research results have not shown consistent clinical benefit in their use in the "general" population of patients with severe
asthma. Rather, the successful use of
macrolides seems to be in those patients with either documented Mycoplasma or
Chlamydophila infection, or noneosinophilic
asthma. Patients with neutrophil predominant phenotype severe
asthma tend to show a decline in exacerbation rate, improved peak expiratory flows, and improved quality of life when treated with
macrolides. This article will review the use of
macrolides in the treatment of
asthma.