Abstract
Background: Long term macrolide treatment has been found beneficial in bronchiectasis (BE) -pathogical bronchial dilatation- possibly due to a combined anti-bacterial and immunomodulatory effect. Here, we investigated the effect of long term macrolide treatment on the inflammatory response in BE. In addition we assessed the inflammatory profile in BE in relation to disease severity.
Methods: During the BAT randomized controlled trial (investigating the effect of 1 year of azithromycin (AZM) in 83 BE patients), data on BE severity, lung function and sputum microbiology was collected. For the current study, a wide range of inflammatory markers were analyzed in 3- monthly sputum samples in all participants.
Results: At baseline, marked neutrophilic but also eosinophilic inflammation was present in both groups, which remained stable throughout the study and was not affected by AZM treatment. Significant upregulation of pro-inflammatory markers correlated with FEV1≤50% (TNFα, ECP, IL-21, IL-1, p=0.007- 0.05), H influenza colonization (MPO, ECP, MIP1, TNFα, IL-21, Il-8, IL-1, IL-1a, p <0.001 – 0.04) and exacerbation frequency (MPO, ECP, VEGF, MMP-9, p=0.003 – 0.01). Surprisingly, colonization with P aeruginosa was found to correlate with an attenuated inflammatory response.
In placebo-treated patients, presence of an infectious exacerbation was reflected by an excessive increase in inflammation as compared to the AZM treated patients.
Conclusion: One year of AZM treatment did not result in attenuation of the inflammatory response in BE. Increasing disease severity and the presence of an exacerbation were reflected by upregulation of pro-inflammatory markers.
Footnotes
Cite this article as: European Respiratory Journal 2019; 54: Suppl. 63, OA4946.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2019