This article is part of Pulmonology Advisor‘s coverage of the American Academy of Allergy, Asthma & Immunology annual meeting, taking place in San Francisco, California. Our staff will report on medical research related to asthma, allergy, and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from AAAAI 2019.


SAN FRANCISCO — The use of macrolide adjunctive therapy has been shown to be safe and effective for the treatment of children with wheezing disease, according to the results of a systematic review and meta-analysis of randomized controlled trials on the topic. Findings were presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2019 Annual Meeting.

Because childhood wheezing disorder may develop into childhood asthma, researchers designed the analysis and review to evaluate the long-term effects of macrolides in pediatric patients with wheezing disease. It is well recognized that macrolides have both anti-inflammatory and antimicrobial properties, and have been used as adjunctive treatment in individuals with a wheezing disorder.

Based on a systematic literature search conducted using an electronic database, a total of 16 randomized controlled trials involving 1415 pediatric patients were examined in the meta-analysis. Results showed that macrolide treatment significantly preserved more pulmonary functions regarding the following parameters: percent of predicted forced expiratory volume in 1 second (FEV1%; difference in means [MD], −9.77; 95% CI, −14.18 to −5.35; P <.001) and forced expiratory flow at 25% to 75% (FEF25-75%; MD, −14.14; 95% CI, −26.11 to −2.18; P =.02).

Short-acting beta agonist usage days and recurrent risk for wheeze were also significantly reduced in patients treated with macrolides (standardized MD [SMD], −0.34 [95% CI, −0.59 to −0.09; P =.007]; and SMD, −0.53 [95% CI, −0.81 to −0.26; P <.001], respectively).

The presence of Moraxella catarrhalis in nasal swabs was significantly lower in children treated with macrolides (odds ratio, 019; 95% CI, 0.11-0.35; P <.001). In addition, pediatric patients with wheeze who were treated with macrolides had a significantly lower risk for the development of adverse events (risk ratio, 0.83; 95% CI, 0.70-0.98; P =.024).

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Findings from this review demonstrated that the use of macrolide adjunctive treatment in children with wheezing is associated with significant long-term outcomes with respect to efficacy and safety.

Reference

Lei WT. The long-term effects of macrolides in children with wheezing: a systematic review and meta-analysis of randomized controlled trials. Presented at: American Academy of Allergy, Asthma & Immunology Annual Meeting; February 22-25, 2019; San Francisco, CA. Abstract 286.