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Long-Term Antibiotic May Reduce COPD Problems

At 1-Year Mark, Azithromycin Reduced COPD Flare-ups
By
WebMD Health News
Reviewed by Laura J. Martin, MD

Lung xray and caduceus

Aug. 23, 2011 -- A common antibiotic, taken for a year, reduced the number of flare-ups in patients with the lung disease known as COPD (chronic obstructive pulmonary disease), according to new research.

''In patients with COPD at high risk for flare-ups, the addition of daily azithromycin for one year reduced the frequency of those events," says researcher Mark Dransfield, MD, director of the University of Alabama at Birmingham Lung Health Center.

COPD is most often caused by smoking. Patients find it difficult to breathe as the disease progresses. They get infections more often, which leads to even more shortness of breath, Dransfield tells WebMD.

"A typical person with moderate to severe COPD gets one to three of these flare-ups each year," he says.

The regimen reduced flare-ups by about 20%, he says.

At least 13 million U.S. adults have COPD.

Minimizing the flare-ups can reduce hospitalizations and improve quality of life, he says. However, some of the side effects of long-term antibiotic use are of concern, he says.

The study is published in The New England Journal of Medicine. The study was funded by the National Institutes of Health.

Antibiotics for COPD: Study Details

Dransfield assigned 570 patients with COPD to take 250 milligrams of azithromycin daily for a year. He assigned 572 others to a placebo pill that looked the same.

About 80% of the patients were also on other medications for COPD. Both groups continued taking other medications, including inhaled steroids and bronchodilators.

COPD can include chronic bronchitis (which involves a chronic cough with mucus) or emphysema (which involves damage to the lungs), or both.

Typically, a patient with COPD who has a flare-up is given a course of antibiotics, but not long-term, Dransfield says.

The researchers decided to look at the long-term treatment because similar regimens have shown promise in other lung diseases, including cystic fibrosis.

Patients were on average aged 65. ''To get into the study, you had to be on oxygen or reported having one of these flare-ups in the previous year,'' Dransfield says.

Compared to placebo, the antibiotic reduced flare-ups by about 20%. At the one-year mark, those in the placebo group had on average 1.83 flare-ups, but those in the antibiotic group had 1.48.

During the study, there were 156 hospitalizations for COPD for the antibiotic group and 200 for the placebo group.

The antibiotic is available generically, Dransfield says. It costs about a dollar a pill.

The regimen had downsides, he tells WebMD. One was hearing loss, which has been found with other antibiotics as well, he says. "We did see a small percent of people with hearing loss, but the differences between drug and placebo was not dramatic," he says. Although 25% of those on medication had a hearing decline when tested, 20% of those on placebo did.

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