Purpose: Macrolides are a recommended treatment option for severe asthma, but data for “difficult-to-treat” asthma, the asthma-COPD “overlap” syndrome, and treatment duration beyond one year are lacking. We present long-term data from community practice experience providing insights for practice and research.
Methods: We report data from (1) baseline (pre-treatment) chart review of antibiotic-treated asthma patients and (2) follow-up telephone interviews documenting severe exacerbations (NIH criteria), Asthma Control Test (ACT) scores, and asthma controller use at baseline and follow-up, analyzed using a “before-after” model.
Results: A total of 101 patients (mean age 55.6 years (Sd 16.8), 66 females) were included. None had ever taken high dose inhaled corticosteroids and 79 (78.2%) were severely uncontrolled (ACT score ≤ 15) before treatment. Coexisting COPD was present in 62 (61.4%) patients. Azithromycin or azithromycin plus doxycycline was primarily prescribed with a median treatment duration of 12 months and median follow-up duration of 22 months. Severe exacerbations in the month before treatment occurred in 50.5% vs 17.8% at follow-up (P< 0.0001). Mean ACT score increased from 12.2 to 20.6 (P< 0.0001). The number of patients taking controller medications decreased (P< 0.0001 for inhaled corticosteroids; P< 0.001 for long-acting beta agonist/long-acting muscarinic antagonist; P< 0.05 for leukotriene receptor antagonists). Of the 79 severely uncontrolled patients, 51 (64.6%) became controlled at follow-up, and of these 51, 27 (52.9%) continued to take antibiotics while 24 (47.1%) had discontinued antibiotics earlier yet remained controlled.
Conclusion: Antibiotic treatment may be beneficial in a significant proportion of “difficult to treat” asthma patients beyond one year, including some patients with the overlap syndrome and/or who fail to meet criteria for refractoriness.

Keywords: asthma, “difficult to treat” asthma, macrolides, tetracyclines, overlap syndrome, case series

中文翻译：

---

“难以治疗”哮喘或重叠综合征成人使用抗生素的结果

目的：大环内酯类是重度哮喘的推荐治疗选择，但缺乏“难以治疗”哮喘、哮喘-COPD“重叠”综合征和超过一年的治疗时间的数据。我们提供来自社区实践经验的长期数据，为实践和研究提供见解。
方法：我们报告的数据来自 (1) 抗生素治疗哮喘患者的基线（治疗前）图表回顾和 (2) 记录严重恶化（NIH 标准）、哮喘控制测试 (ACT) 评分和哮喘的后续电话访谈控制器在基线和后续使用，使用“前后”模型进行分析。
结果：共纳入 101 名患者（平均年龄 55.6 岁（标准差 16.8），66 名女性）。没有人服用过大剂量吸入皮质类固醇，79 人（78.2%）在治疗前严重失控（ACT 评分≤15）。62 名 (61.4%) 患者同时存在 COPD。阿奇霉素或阿奇霉素加多西环素的主要处方是中位治疗时间为 12 个月，中位随访时间为 22 个月。治疗前一个月的严重恶化发生率为 50.5%，而随访时为 17.8%（P<0.0001）。平均 ACT 分数从 12.2 增加到 20.6 (P<0.0001)。服用控制药物的患者人数减少（吸入皮质类固醇 P < 0.0001；长效 β 激动剂/长效毒蕈碱拮抗剂 P < 0.001；白三烯受体拮抗剂 P < 0.05）。
结论：抗生素治疗可能对很大一部分超过一年的“难以治疗”的哮喘患者有益，包括一些患有重叠综合征和/或不符合难治性标准的患者。

关键词：哮喘，“难治性”哮喘，大环内酯类，四环素类，重叠综合征，病例系列