Antibiotics don’t speed recovery from asthma attacks

Nandini Mani, MD
Nandini Mani, MD, Contributing Editor

Does winter in the Northeast make you think of snowmen, warm fires, and hot chocolate? Or, does it instead inspire visions of runny noses, congestion, and cough? Although it is less rosy, I know readers with asthma may be picturing the latter.

People with asthma get respiratory infections more often

In general, people with asthma tend to get sick more easily, and illnesses can trigger asthma attacks. In my practice, we generally start seeing an increase in the number of asthma attacks, or asthma flares, once the ground frosts. If you are fortunate enough not to have asthma, chances are that you know somebody who does. The Centers for Disease Control and Prevention  reports that rates of asthma in the United States are soaring, such that today, 1 in 12 people has it. Because people with asthma get sick more often, it is logical to suspect that they will often be prescribed antibiotics. But do antibiotics really help? New research is helping to answer this very question.

Do antibiotics help people with asthma get back to normal faster?

A study recently published in the Journal of American Medicine Association looked at the effectiveness of an antibiotic called azithromycin for treating asthma attacks. The trial, nicknamed AZALEA, aimed to look at whether adding azithromycin to the usual treatment helped people recover from asthma attacks more quickly.  This was of interest to the researchers for several reasons: For starters, azithromycin is a very commonly prescribed antibiotic, so it is important to know if it works. Also, studies showed that an older drug called telithromycin actually did help people heal from asthma attacks more quickly. Doctors rarely prescribe telithromycin today because it can cause serious side effects. But azithromycin is similar in many ways, so it might be a good alternative.

Azithromycin did not help the asthma attacks  improve

Participants in the study were separated into two groups. One group was given usual treatment for an asthma attack (a high potency anti-inflammatory pill and breathing treatments), plus azithromycin. The other group was given standard treatment for an asthma attack plus a placebo, or sugar pill. To help reduce confusion, the researchers excluded asthma sufferers who had taken antibiotics — for any reason — during the four weeks prior to the study.. At the end of the study, the researchers concluded that both groups recovered from their asthma attacks at the same speed.

This means  azithromycin did not make people recover any better or any faster, and those that did not receive  azithromycin still got better.

So, should you take antibiotics for asthma? No, but there are rare exceptions

There are several take-aways  from this study. First, azithromycin did not make any difference in making people with asthma attacks feel better. As a clinician, this makes a lot of sense to me. Azithromycin was the most commonly prescribed antibiotic in the U.S. in 2010, and remains heavily prescribed today. But it’s popularity comes at a cost. Many of the bacteria that typically cause respiratory infections in adults have become resistant to it. Furthermore, most adults with asthma attacks will have viral respiratory infections, and antibiotics don’t  kill viruses. That’s why I rarely prescribe an antibiotic for an asthma attack. When I do, I rarely prescribe azithromycin, because it will only work on a small fraction of bacteria. There are certainly some exceptions; smokers, in particular, can be different. But overall, the results of this study make intuitive sense.

A second, and very interesting, conclusion was that 90% of the asthmatics initially considered for  entry into this study had received antibiotics in the preceding month! We don’t know why these antibiotics were prescribed, but the rate of antibiotics prescribed for people with asthma is concerning. Common sense makes me suspect that this is too high a rate of antibiotic prescription. I’ve never yet had the need to give 9 out of 10 patients I see antibiotics. This makes me worry that antibiotics may be over-prescribed in asthmatics, and I would like to know why.

I hope that everyone out there has as healthy a winter as possible, filled only with snowmen, warm fires, and hot chocolate. For the asthma sufferers out there, I hope you know that research like this helps us providers learn how to take care of you better. And that is a very warm thought.

Comments:

  1. John Grace

    Is there a different study looking at the effects of azithromycin on lung inflammation taken over a longer period of time and not just on the effect on an asthma attack? I am currently doing this treatment under my Dr’s order and would be interested in knowing more about this study.

  2. Clarissa

    For years, as an asthmatic, every time I got my usual “chronic bronchitis” in the winter. Off I went with my Z-Pack — after suffering 2-3 weeks of goopy coughs, Mucinex DM, Tussin DM, humidifiers, bags of cough drops, and sleepless nights, and if I was lucky–(or looking in super rough shape) codeine cough syrup so I could finally pass out.
    Surprise. Z-pack is not the cure! It’s viral not bacterial, duh.

    I know now, according to my lung specialist that it’s called an “acute asthma attack” not bronchitis, and to take Prednisone (along with my usual preventive inhalers) when I can’t get it under control. And THAT helps fast. No more 3 months of suffering through “bronchitis”

  3. roberta hobbs

    Hi There, I think this is a very interesting subject. ( I have brittle asthma, moderate to severe.) I have been taking a low dose of Azithromycin 3 times a week since September prescribed by my consultant. (As an add on to all the other medicine I take), I’m not at all sure that this has any effect whatsoever, but there seems to be some research that says Azithromycin taken long term can have an anti-inflammatory effect. Anyway I promised to take it for 6 months.

    Also I find that all my doctors are always very quick to suggest taking Anti-Biotics when I have a flare-up. (Along with all the usual suspects, prednisolone and nebules). I think sometimes doctors feel very helpless particularly when dealing with asthma as they desperately want to keep you out of the emergency room. So will throw all “guns”at the problem because, waiting to get a sputum test analysed might be the difference between ER or “getting ahead of the curve”. So I think this may be part of the reason that doctors prescribe us Asthmatics so many Anti-Biotics.

    I have a general rule about taking Anti-biotics, which means I generally don’t start taking them until I have been unwell for at least 10 days, having probably gotten better but then got worse again and have a fever. Sometimes my PCP’s override this, but I think that on the spectrum of Asthma I get can get pretty sick.
    I think to get doctors to write less scripts and patients to take less Anti-Biotics, people with Asthma need to have a written asthma plan, they need to step up medication before they get really sick, I.E, I step up my meds if a family member gets a cold. And they need to know when Anti-biotics are a good idea. An Emergency room visit is not what anyone wants.

    • Clarissa Goldberg

      You shouldn’t have a “general rule” for taking antibiotics. It’s not “after 10’days” it’s NOT AT ALL UNLESS ITS BACTERIAL.
      Zpack after 2 weeks or 2’days isn’t the answer. You need to go to a lung specialist like I did and stop wth PCP’s “throwing antibiotics at you”
      Prednisone is the answer when you are having an “acute asthma attack” which is what my lung specialist told me to call it and to STOP calling it chronic bronchitis. I have asthma. It can get awful in winter but it’s NOT bronchitis and it gets better ONLY with prednisone when all else fails (mucinex dm, tussin dm, humidifiers, cough drops, inhalers, codeine cough syrup….) enough with the antibiotics! That was the whole point of the article.