Effect Of Low-Dose Treatment With Erythromycin On The Th1/Tc1-Mediated Airway Inflammation And Exercise Tolerance In Patients With Stable Chronic Obstructive Pulmonary

Objectives To study the effect of low-dose and long-term treatment with erythromycin on pulmonary function, respiratory symptoms, exercise tolerance, the quality of quality and the Thl/Tc1-mediated airway inflammation in patients with stable chronic obstructive pulmonary disease (COPD).Methods A total of thirty-six subjects with stable COPD(Ⅱ～Ⅳ)were recruited. They were divided into erythromycin group (n=18) and control group (n=18) with a prospective randomized, controlled method, the former were subdivided into one-year group (n=9, oral erythromycin 375mg daily for one year) and six-month group (n=9, oral erythromycin 375mg daily for half of a year). All subjects were kept up their previous treatments. The total and differential leukocyte counts in induced sputum, pulmonary function, six-minute walking distance (6MWD), the dyspnea score, the life quality score were measured at day 1, month 6 and month 12 respectively and the concentrations of interferon-gamma (y-IFN), interleukin-8 (IL-8), interleukin-10 (IL-10), interleukin-12 (IL-12), tumor necrosis factor-alpha (TNF-α) in the supernatant of sputum and blood by enzyme-linked immunosorbent assay (ELISA).Results:1 Total leukocyte counts and neutrophil counts at month 6, month 12 in one-year group and at month 6 in six-month group were reduced compared to those in control group and also declined compared to those before treatment (p<0.05).2 The concentrations of y-IFN, TNF-a, IL-8 were lower while the concentrations of IL-10 were higher in both blood and sputum at month 6, month 12 in one-year group and at month 6 in six-month group than those in control group (p<0.05).3 The concentrations of y-IFN, TNF-a, IL-8, IL-12 were decreased while the concentrations of IL-10 were increased in both blood and sputum at month 6, month 12 in one-year group and at month 6 in six-month group compared to those at day 1. The concentrations of TNF-α,IL-8, IL-12 in sputum and the concentration of IL-12 in blood were also raised by contrast with those before treatment (p<0.05).4 Contrast with those at day 1, the general health (GH) score was upgraded at month 6 in six-month group whereas the physical function (PH) score and the vitality (VT) score were downgraded at both month 6 and month 12 in six-month group (p<0.05).5 Inspiratory capacity (IC),6MWD were increased at month 6, month 12 in one-year group and at month 6 in six-month group compared to those in control group.6MWD were improved in both one-year group and six-month group after treatment (p<0.05). 6 Total leukocyte counts, neutrophil counts, the concentrations of IL-8 and TNF-a in sputum, the concentration of TNF-a in blood at month 12 in one-year group were reduced compared to those in six-month group (p<0.05).Conclusion The treatment of six-month low-dose erythromycin can inhibit Thl/Tcl-mediated airway inflammation, increase the exercise tolerance and improve pulmonary function to a certain extent. The airway inflammation rebounds after drug withdrawal while can be continuously inhibited by the treatment of 12-month erythromycin.