PT - JOURNAL ARTICLE AU - Simon D. Fraser AU - Susannah Thackray-Nocera AU - Marica Shepherd AU - Rachel Flockton AU - Caroline Wright AU - Wayne Sheedy AU - Kayleigh Brindle AU - Alyn H. Morice AU - Paul M. Kaye AU - Michael G. Crooks AU - Simon P. Hart TI - Azithromycin for sarcoidosis cough: an open label exploratory clinical trial AID - 10.1183/23120541.00534-2020 DP - 2020 Jan 01 TA - ERJ Open Research PG - 00534-2020 4099 - http://openres.ersjournals.com/content/early/2020/09/17/23120541.00534-2020.short 4100 - http://openres.ersjournals.com/content/early/2020/09/17/23120541.00534-2020.full AB - Background Chronic cough is a distressing symptom for many people with pulmonary sarcoidosis. Continuous treatment with a macrolide antibiotic may improve cough. We aimed to assess the potential efficacy of azithromycin in patients with sarcoidosis and self-reported cough.Methods We did a non-controlled, open label clinical trial of azithromycin 250 mg once daily for 3 months in patients with pulmonary sarcoidosis who reported a chronic cough. The primary outcome was number of coughs in 24 h. Secondary outcomes were cough visual analog scales and quality of life measured using the Leicester Cough Questionnaire and King's Sarcoidosis Questionnaire. Safety outcomes included QTc interval on ECG. Measurements were made at baseline and after one and 3 months of treatment.Results All 21 patients were white, median age 57 years, 9 males/12 females, median 3 years since diagnosis. Five were taking oral corticosteroids and none were taking other immunosuppressants. Twenty patients completed the trial. The median (range) number of coughs in 24 h was 228 (43–1950) at baseline, 122 (20–704) at 1 month, and 81 (16–414) at 3 months (p=0.002, Friedman's test). The median reduction in cough count at 3 months was 49.6%. There were improvements in all patient-reported outcomes. Azithromycin was well tolerated.Conclusion In a non-controlled open-label trial in people with sarcoidosis who reported a chronic cough, 3 months of treatment with azithromycin led to improvements in a range of cough metrics. Azithromycin should be tested as a treatment for sarcoidosis cough in a randomised placebo-controlled trial.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. Fraser reports grants from SarcoidosisUK, during the conduct of the study.Conflict of interest: Dr. Thackray-Nocera has nothing to disclose.Conflict of interest: Dr. Shepherd has nothing to disclose.Conflict of interest: R Flockton has nothing to disclose.Conflict of interest: Dr. Wright has nothing to disclose.Conflict of interest: Dr. Sheedy has nothing to disclose.Conflict of interest: Dr. Brindle has nothing to disclose.Conflict of interest: Dr. Morice has nothing to disclose.Conflict of interest: Dr. Kaye reports grants from SarcoidosisUK, during the conduct of the study.Conflict of interest: Dr. Crooks reports grants from Sarcoidosis UK, during the conduct of the study.Conflict of interest: Dr. Hart reports grants from SarcoidosisUK, during the conduct of the study.