Effectiveness And Safety Of Azithromycin In The Adjuvant Treatment Of Bronchial Asthma:a Meta-analysis

Objective: To estimate the effectiveness and safety of the use of azithromycin in the adjuvant treatment in children and adults with bronchial asthma.Methods: We searched the PubMed,Cochrane Library,EMBASE,CBM,CNKI,VIP and Wanfang database from inception to September 2017.The criteria from the Cochrane Handbook for Systematic Reviews of Interventions(35)was used to assess the risk of bias of the included studies.Six outcomes were considered in the analysis which are the acute exacerbation,rescue medication,AQLQ,ACQ,pulmonary function and adverse drug reaction.Meta-analysis were performed using RevMan5.3 with a random-effect model.Results: Ten studies met the inclusion criteria,randomising a total of 1060 participants to receive azithromycin or nothing.(1)For prevention acute exacerbation,there was no significant difference between the azithromycin group and the control group(RR = 0.75,95% CI: 0.43-1.31,P = 0.31).But in the subgroups analysis,there was a statistically significant in the non-eosinophils asthma(RR = 0.62,95% CI: 0.45-0.86,P = 0.004).(2)For rescue medication,there was no significant difference(WMD = 0.05,95% CI =-0.49-0.59,P = 0.85).(3)For the control of asthma,the AQLQ(WMD=0.05,95% CI=-0.18~0.28,P=0.70)or ACQ(WMD=-0.02,95% CI=-0.15~0.11,P=0.82)were not affected by azithromycin no significant.(4)In the pulmonary function,azithromycin treatment significantly improved PEF(WMD = 0.09,95% CI = 0.05-0.1313,P <0.0001),FEV1(WMD = 3.56,95% CI = 0.80-6.72,P = 0.01).(5)adverse drug reaction,azithromycin increases the risk of nausea(RR=0.62,95% CI:0.45 ~ 0.86,P = 0.004)and diarrhea(RR=0.62,95% CI:0.45 ~ 0.86,P = 0.004).Conclusion: The Azithromycin for part persistent asthma treatment possible prevents acute exacerbation,can improve PEF and FEV1,but shows no significant effect on rescue medication and the quality of life of the patients.Long-term using may increase the risk of nausea,diarrhea and other gastrointestinal adverse,no other serious adverse.