Role of macrolide therapy in chronic obstructive pulmonary disease

Review

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Authors: Fernando J Martinez, Jeffrey L Curtis, Richard Albert

Published Date October 2008 Volume 2008:3(3) Pages 331 - 350

DOI: http://dx.doi.org/10.2147/COPD.S681

Fernando J Martinez¹, Jeffrey L Curtis^1,2, Richard Albert³

¹Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA; ²Pulmonary and Critical Care Medicine Section, Ann Arbor VA Health System, Ann Arbor, MI, USA; ³Division of Pulmonary and Critical Care Medicine, Denver Health Medical Center and University of Colorado, Denver, CO, USA

Abstract: Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability worldwide. The Global Burden of Disease study has concluded that COPD will become the third leading cause of death worldwide by 2020, and will increase its ranking of disability-adjusted life years lost from 12th to 5th. Acute exacerbations of COPD (AECOPD) are associated with impaired quality of life and pulmonary function. More frequent or severe AECOPDs have been associated with especially markedly impaired quality of life and a greater longitudinal loss of pulmonary function. COPD and AECOPDs are characterized by an augmented inflammatory response. Macrolide antibiotics are macrocyclical lactones that provide adequate coverage for the most frequently identified pathogens in AECOPD and have been generally included in published guidelines for AECOPD management. In addition, they exert broad-ranging, immunomodulatory effects both in vitro and in vivo, as well as diverse actions that suppress microbial virulence factors. Macrolide antibiotics have been used to successfully treat a number of chronic, inflammatory lung disorders including diffuse panbronchiolitis, asthma, noncystic fibrosis associated bronchiectasis, and cystic fibrosis. Data in COPD patients have been limited and contradictory but the majority hint to a potential clinical and biological effect. Additional, prospective, controlled data are required to define any potential treatment effect, the nature of this effect, and the role of bronchiectasis, baseline colonization, and other comorbidities.

Keywords: macrolide therapy, antibiotics, AECOPD