COPD & Emphysema Support Group
COPD is a progressive disease characterized by airflow obstruction or limitation. Emphysema is characterized by loss of elasticity of the lung tissue, destruction of structures supporting the alveoli and of capillaries feeding the alveoli. Both have symptoms that include shortness of breath, among other respiratory troubles. If you are a COPD or Emphysema sufferer, join...
Long-term erythromycin therapy decreases COPD exacerbations February 20, 2009
Clinical question Does the long-term use of erythromycin reduce exacerbations in patients with moderate to severe chronic obstructive pulmonary disease (COPD)?
Bottom line In patients with moderate to severe COPD, twice daily erythromycin reduced the frequency of exacerbations and had a similar rate of adverse side effects as placebo at the end of 1 year. (Level of evidence = 1b)
Synopsis To be included in this study, patients had to have moderate to severe COPD based on spirometry and not have used antibiotics or corticosteroids during a run-in period. Unlike other studies where patients receive study medication during the run-in period to weed out patients who are nonadherent or unable to tolerate the medication, the run-in period for this study was used merely to ensure that the patients had no exacerbations before baseline data were collected. Patients were randomized to receive 250 mg erythromycin twice daily (n = 53) or placebo (n = 56) for 12 months. In addition to physiologic data, the patients also kept track of the number of moderate or severe exacerbations. A moderate exacerbation of COPD was defined as sustained worsening of symptoms for at least 2 days treated with antibiotics, corticosteroids, or both. A severe exacerbation was defined as those resulting in hospital admission. Exacerbations were evaluated by a researcher unaware of the patient's treatment group assignment. The researchers used intention to treat to assess the outcomes. By the end of 12 months, nine patients treated with erythromycin withdrew from the study compared with 10 treated with placebo (one of whom died). The two treatment groups were similar at baseline. Among patients treated with erythromycin, there were 81 moderate to severe exacerbations compared with 125 in patients treated with placebo. The median frequency of exacerbations was two for patients taking placebo and one for patients taking erythromycin. The median time to the first exacerbation was also longer in patients taking erythromycin (271 days vs 89 days). The duration of exacerbations was also shorter in the erythromycin group: 13 days (95% CI, 16-24) versus 9 days (6-14). Although there were 6 hospitalizations (7.4%) in patients treated with erythromycin compared with 14 (11.2%) for patients treated with placebo, the study lacked power to detect meaningful differences in this outcome. There were no differences in adverse effects in either group.
Seemungal TA, Wilkinson TM, Hurst JR, et al. Long-term erythromycin therapy is associated with decreased chronic obstructive pulmonary disease exacerbations. Am J Respir Crit Care Med. 2008;178(11):1139-1147.
http://www.jaapa.com/Long-term-erythromycin-therapy-decreases-COPD-exacerbations/article/127659/
Clinical question Does the long-term use of erythromycin reduce exacerbations in patients with moderate to severe chronic obstructive pulmonary disease (COPD)?
Bottom line In patients with moderate to severe COPD, twice daily erythromycin reduced the frequency of exacerbations and had a similar rate of adverse side effects as placebo at the end of 1 year. (Level of evidence = 1b)
Synopsis To be included in this study, patients had to have moderate to severe COPD based on spirometry and not have used antibiotics or corticosteroids during a run-in period. Unlike other studies where patients receive study medication during the run-in period to weed out patients who are nonadherent or unable to tolerate the medication, the run-in period for this study was used merely to ensure that the patients had no exacerbations before baseline data were collected. Patients were randomized to receive 250 mg erythromycin twice daily (n = 53) or placebo (n = 56) for 12 months. In addition to physiologic data, the patients also kept track of the number of moderate or severe exacerbations. A moderate exacerbation of COPD was defined as sustained worsening of symptoms for at least 2 days treated with antibiotics, corticosteroids, or both. A severe exacerbation was defined as those resulting in hospital admission. Exacerbations were evaluated by a researcher unaware of the patient's treatment group assignment. The researchers used intention to treat to assess the outcomes. By the end of 12 months, nine patients treated with erythromycin withdrew from the study compared with 10 treated with placebo (one of whom died). The two treatment groups were similar at baseline. Among patients treated with erythromycin, there were 81 moderate to severe exacerbations compared with 125 in patients treated with placebo. The median frequency of exacerbations was two for patients taking placebo and one for patients taking erythromycin. The median time to the first exacerbation was also longer in patients taking erythromycin (271 days vs 89 days). The duration of exacerbations was also shorter in the erythromycin group: 13 days (95% CI, 16-24) versus 9 days (6-14). Although there were 6 hospitalizations (7.4%) in patients treated with erythromycin compared with 14 (11.2%) for patients treated with placebo, the study lacked power to detect meaningful differences in this outcome. There were no differences in adverse effects in either group.
Seemungal TA, Wilkinson TM, Hurst JR, et al. Long-term erythromycin therapy is associated with decreased chronic obstructive pulmonary disease exacerbations. Am J Respir Crit Care Med. 2008;178(11):1139-1147.
http://www.jaapa.com/Long-term-erythromycin-therapy-decreases-COPD-exacerbations/article/127659/
Thank you for sharing some supportive information re COPD
Wishing you well x
Great post, and I'm glad they are doing the research. Hugs, Sue
My uncle Allen prescribed erythromycin therapy for my father for many years during his illness between 1976 and 1987. My father never seemed to have bad exacerbations and they were few, I dont know if the erythromycin therapy was the reason, or if it was that he exercised regularly and ate a very good diet and we all avoided bring him colds etc. Maybe it was just luck...but I know this history of my fathers which makes me more interested in this study.
I am interested in the out come...
Love to all
Holly
Thanks for all you recent great postings - hugs