Am. J. Respir. Crit. Care Med., Volume 164, Number 4, August 2001, 536-541

Trial of Roxithromycin in Subjects with Asthma and Serological Evidence of Infection with Chlamydia pneumoniae

PETER N. BLACK, FRANCESCO BLASI, CHRISTINE R. JENKINS, RAFFAELE SCICCHITANO, GRAHAM D. MILLS, ABRAHAM R. RUBINFELD, RICHARD E. RUFFIN, PETER R. MULLINS, JOSETTE DANGAIN, BRUCE C. COOPER, DENISE BEM DAVID, and LUIGI ALLEGRA

Auckland Hospital, Auckland, New Zealand; Institute of Respiratory Disease, University of Milan, IRCCS Ospedale Maggiore, Milan, Italy; Royal Prince Alfred Hospital, Sydney, Australia; Royal Adelaide Hospital, Adelaide, Australia; Waikato Hospital, Hamilton, New Zealand; Royal Melbourne Hospital, Melbourne, Australia; Queen Elizabeth Hospital, Adelaide, Australia; Department of Statistics, University of Auckland, Auckland, New Zealand; Aventis Pharma, Sydney, Australia; and Aventis Pharma, Romanville, France

An association has been reported between chronic infection with Chlamydia pneumoniae and the severity of asthma, and uncontrolled observations have suggested that treatment with antibiotics active against C. pneumoniae leads to an improvement in asthma control. We studied the effect of roxithromycin in subjects with asthma and immunoglobulin G (IgG) antibodies to C. pneumoniae  1:64 and/or IgA antibodies  1:16. A total of 232 subjects, from Australia, New Zealand, Italy, or Argentina, were randomized to 6 wk of treatment with roxithromycin 150 mg twice a day or placebo. At the end of 6 wk, the increase from baseline in evening peak expiratory flow (PEF) was 15 L/min with roxithromycin and 3 L/min with placebo (p = 0.02). With morning PEF, the increase was 14 L/min with roxithromycin and 8 L/min with placebo (NS). In the Australasian population, the increase in morning PEF was 18 L/min and 4 L/min, respectively (p = 0.04). At 3 mo and 6 mo after the end of treatment, differences between the two groups were smaller and not significant. Six weeks of treatment with roxithromycin led to improvements in asthma control but the benefit was not sustained. Further studies are necessary to determine whether the lack of sustained benefit is due to failure to eradicate C. pneumoniae.

Keywords: asthma; Chlamydia pneumoniae; roxithromycin; randomized, controlled trial

This article has been cited by other articles:

				A. Beigelman, S. Gunsten, C. L. Mikols, I. Vidavsky, C. L. Cannon, S. L. Brody, and M. J. Walter Azithromycin Attenuates Airway Inflammation in a Noninfectious Mouse Model of Allergic Asthma Chest, August 1, 2009; 136(2): 498 - 506. [Abstract] [Full Text] [PDF]

				P. A. J. Crosbie and M. A. Woodhead Long-term macrolide therapy in chronic inflammatory airway diseases Eur. Respir. J., January 1, 2009; 33(1): 171 - 181. [Abstract] [Full Text] [PDF]

				J. L. Simpson, H. Powell, M. J. Boyle, R. J. Scott, and P. G. Gibson Clarithromycin Targets Neutrophilic Airway Inflammation in Refractory Asthma Am. J. Respir. Crit. Care Med., January 15, 2008; 177(2): 148 - 155. [Abstract] [Full Text] [PDF]

				E. R. Sutherland and R. J. Martin Asthma and Atypical Bacterial Infection Chest, December 1, 2007; 132(6): 1962 - 1966. [Abstract] [Full Text] [PDF]

				S. L. Johnston, F. Blasi, P. N. Black, R. J. Martin, D. J. Farrell, R. B. Nieman, and the TELICAST Investigators The Effect of Telithromycin in Acute Exacerbations of Asthma N. Engl. J. Med., April 13, 2006; 354(15): 1589 - 1600. [Abstract] [Full Text] [PDF]

				S. L. Johnston and R. J. Martin Chlamydophila pneumoniae and Mycoplasma pneumoniae: A Role in Asthma Pathogenesis? Am. J. Respir. Crit. Care Med., November 1, 2005; 172(9): 1078 - 1089. [Abstract] [Full Text] [PDF]

				N Teig, A Anders, C Schmidt, C Rieger, and S Gatermann Chlamydophilapneumoniae and Mycoplasma pneumoniae in respiratory specimens of children with chronic lung diseases Thorax, November 1, 2005; 60(11): 962 - 966. [Abstract] [Full Text] [PDF]

				G.L. Biscione, J. Corne, A.J. Chauhan, and S.L. Johnston Increased frequency of detection of Chlamydophila pneumoniae in asthma Eur. Respir. J., November 1, 2004; 24(5): 745 - 749. [Abstract] [Full Text] [PDF]

				F. Blasi Atypical pathogens and respiratory tract infections Eur. Respir. J., July 1, 2004; 24(1): 171 - 182. [Abstract] [Full Text] [PDF]

				M. H. Gotfried Macrolides for the Treatment of Chronic Sinusitis, Asthma, and COPD Chest, February 1, 2004; 125 (2009): 52S - 61S. [Abstract] [Full Text] [PDF]

				S. G. Gerhardt, J. F. McDyer, R. E. Girgis, J. V. Conte, S. C. Yang, and J. B. Orens Maintenance Azithromycin Therapy for Bronchiolitis Obliterans Syndrome: Results of a Pilot Study Am. J. Respir. Crit. Care Med., July 1, 2003; 168(1): 121 - 125. [Abstract] [Full Text] [PDF]

				R. F. Lemanske Jr. Is Asthma an Infectious Disease?: Thomas A. Neff Lecture Chest, March 1, 2003; 123 (2009): 385S - 390S. [Abstract] [Full Text] [PDF]

				D. Lieberman, D. Lieberman, S. Printz, M. Ben-Yaakov, Z. Lazarovich, B. Ohana, M. G. Friedman, B. Dvoskin, M. Leinonen, and I. Boldur Atypical Pathogen Infection in Adults with Acute Exacerbation of Bronchial Asthma Am. J. Respir. Crit. Care Med., February 1, 2003; 167(3): 406 - 410. [Abstract] [Full Text] [PDF]

				M. J. TOBIN Asthma, Airway Biology, and Nasal Disorders in AJRCCM 2001 Am. J. Respir. Crit. Care Med., March 1, 2002; 165(5): 598 - 618. [Full Text] [PDF]

				S. L. Johnston Is Chlamydia pneumoniae Important in Asthma? . The First Controlled Trial of Therapy Leaves the Question Unanswered Am. J. Respir. Crit. Care Med., August 15, 2001; 164(4): 513 - 514. [Full Text] [PDF]