Azithromycin for prevention of exacerbations in non-cystic fibrosis bronchiectasis (EMBRACE): a randomised, double-blind, placebo-controlled trial
Abstract
Background Azithromycin is a macrolide antibiotic with anti-inflammatory and immunomodulatory properties. We tested the hypothesis that azithromycin would decrease the frequency of exacerbations, increase lung function, and improve health-related quality of life in patients with non-cystic fibrosis bronchiectasis.Methods We undertook a randomised, double-blind, placebo-controlled trial at three centres in New Zealand. Between Feb 12, 2008, and Oct 15, 2009, we enrolled patients who were 18 years or older, had had at least one pulmonary exacerbation requiring antibiotic treatment in the past year, and had a diagnosis of bronchiectasis defined by high-resolution CT scan. We randomly assigned patients to receive 500 mg azithromycin or placebo three times a week for 6 months in a 1:1 ratio, with a permuted block size of six and sequential assignment stratified by centre. Participants, research assistants, and investigators were masked to treatment allocation. The coprimary endpoints were rate of event-based exacerbations in the 6-month treatment period, change in forced expiratory volume in 1 s (FEV(1)) before bronchodilation, and change in total score on St George's respiratory questionnaire (SGRQ). Analyses were by intention to treat. This study is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12607000641493.Findings 71 patients were in the azithromycin group and 70 in the placebo group. The rate of event-based exacerbations was 0·59 per patient in the azithromycin group and 1·57 per patient in the placebo group in the 6-month treatment period (rate ratio 0·38, 95% CI 0·26-0·54; p<0·0001). Prebronchodilator FEV(1) did not change from baseline in the azithromycin group and decreased by 0·04 L in the placebo group, but the difference was not significant (0·04 L, 95% CI -0·03 to 0·12; p=0·251). Additionally, change in SGRQ total score did not differ between the azithromycin (-5·17 units) and placebo groups (-1·92 units; difference -3·25, 95% CI -7·21 to 0·72; p=0·108).Interpretation Azithromycin is a new option for prevention of exacerbations in patients with non-cystic fibrosis bronchiectasis with a history of at least one exacerbation in the past year.Funding Health Research Council of New Zealand and Auckland District Health Board Charitable Trust.
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The intervention most consistently proven to decrease exacerbation frequency in COPD, cystic fibrosis, and bronchiectasis is azithromycin.
“The intervention most consistently proven to decrease exacerbation frequency (in COPD,143 cystic fibrosis144 and bronchiectasis145) is azithromycin, a macrolide antibiotic.”
From The microbiome and critical illness (2016) · cites this paper as [145]
Cites
ATS Statement: Guidelines for the Six-Minute Walk Test
(2002) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.166.1.at1102 · Cited by 11,195 · see citing works
Azithromycin for prevention of exacerbations of COPD
Albert, R. K., Connett, J., Bailey, W. C., Casaburi, R., Cooper, J. A. D., Criner, G. J., Curtis, J. L., Dransfield, M. T., Han, M. K., Lazarus, S. C., et al. (2011) · New England Journal of Medicine · doi:10.1056/nejmoa1104623 · Cited by 1,226 · see citing works
British Thoracic Society guideline for non-CFbronchiectasis
Pasteur, M. C., Bilton, D., Hill, A. T., & on behalf of the British Thoracic Society Bronchiectasis (non-CF) Guideline Group (2010) · Thorax · doi:10.1136/thx.2010.136119 · Cited by 1,043 · see citing works
Saiman, L., Marshall, B. C., Mayer-Hamblett, N., Burns, J. L., Quittner, A. L., Cibene, D. A., Coquillette, S., Fieberg, A. Y., Accurso, F. J., Campbell III, P. W., et al. (2003) · JAMA · doi:10.1001/jama.290.13.1749 · Cited by 958 · see citing works
Azithromycin and the Risk of Cardiovascular Death
Ray, W. A., Murray, K. T., Hall, K., Arbogast, P. G., & Stein, C. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1003833 · Cited by 958 · see citing works
Mechanisms of Action and Clinical Application of Macrolides as Immunomodulatory Medications
Kanoh, S., & Rubin, B. K. (2010) · Clinical Microbiology Reviews · doi:10.1128/cmr.00078-09 · Cited by 710 · see citing works
COPD exacerbations: definitions and classifications
Burge, S., & Wedzicha, J. A. (2003) · European Respiratory Journal · doi:10.1183/09031936.03.00078002 · Cited by 662 · see citing works
Barker, A. F. (2002) · New England Journal of Medicine · doi:10.1056/nejmra012519 · Cited by 545 · see citing works
Equi, A., Balfour-Lynn, I. M., Bush, A., & Rosenthal, M. (2002) · The Lancet · doi:10.1016/s0140-6736(02)11081-6 · Cited by 542 · see citing works
Malhotra‐Kumar, S., Lammens, C., Coenen, S., Herck, K. V., & Goossens, H. (2007) · The Lancet · doi:10.1016/s0140-6736(07)60235-9 · Cited by 541 · see citing works
Wolter, J. M. (2002) · Thorax · doi:10.1136/thorax.57.3.212 · Cited by 516 · see citing works
Martínez‐García, M. Á., Soler‐Cataluña, J. J., Perpiñá-Tordera, M., Román-Sánchez, P., & Soriano, J. B. (2007) · CHEST Journal · doi:10.1378/chest.07-0490 · Cited by 484 · see citing works
Treatment of Idiopathic Bronchiectasis With Aerosolized Recombinant Human DNase I
O’Donnell, A. E., Barker, A. F., Ilowite, J. S., & Fick, R. B. (1998) · CHEST Journal · doi:10.1378/chest.113.5.1329 · Cited by 440 · see citing works
Mortality in bronchiectasis: a long-term study assessing the factors influencing survival
Loebinger, M. R., Wells, A. U., Hansell, D. M., Chinyanganya, N., Devaraj, A., Meister, M. G., & Wilson, R. (2009) · European Respiratory Journal · doi:10.1183/09031936.00003709 · Cited by 414 · see citing works
Validation of the St. George's Respiratory Questionnaire in Bronchiectasis
Wilson, C., JONES, P. W., O’Leary, C., COLE, P. J., & Wilson, R. C. (1997) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.156.2.9607083 · Cited by 387 · see citing works
Saiman, L. M. (2010) · JAMA · doi:10.1001/jama.2010.563 · Cited by 326 · see citing works
Trends in Bronchiectasis Among Medicare Beneficiaries in the United States, 2000 to 2007
Seitz, A. E., Olivier, K. N., Adjemian, J., Holland, S. M., & Prevots, D. R. (2012) · CHEST Journal · doi:10.1378/chest.11-2209 · Cited by 319 · see citing works
Azithromycin blocks autophagy and may predispose cystic fibrosis patients to mycobacterial infection
Renna, M., Schaffner, C., Brown, K., Shang, S., Henao-Tamayo, M. I., Hegyi, K., Grimsey, N. J., Cusens, D., Coulter, S., Cooper, J. F., et al. (2011) · Journal of Clinical Investigation · doi:10.1172/jci46095 · Cited by 316 · see citing works
Clément, A. (2006) · Thorax · doi:10.1136/thx.2005.057950 · Cited by 294 · see citing works
Characterisation of the onset and presenting clinical features of adult bronchiectasis
King, P. T., Holdsworth, S. R., Freezer, N., Villanueva, E., & Holmes, P. W. (2006) · Respiratory Medicine · doi:10.1016/j.rmed.2006.03.012 · Cited by 268 · see citing works
Methods of sputum processing for cell counts, immunocytochemistry andin situhybridisation
Leader of the Working Group: A. Efthimiadis1, A. S., Members of the Working Group:, Hamid, Q. A., Kelly, M. M., Linden, M., Louis, R., Pizzichini, M. M. M., Pizzichini, E., Ronchi, C. L., van Overveld, F. J., et al. (2002) · European Respiratory Journal · doi:10.1183/09031936.02.00001902 · Cited by 258 · see citing works
Trends and Burden of Bronchiectasis-Associated Hospitalizations in the United States, 1993-2006
Seitz, A. E., Olivier, K. N., Steiner, C., de Oca, R. M., Holland, S. M., & Prevots, D. R. (2010) · CHEST Journal · doi:10.1378/chest.10-0099 · Cited by 238 · see citing works
Airway Inflammation in Cystic Fibrosis
Elizur, A., Cannon, C. L., & Ferkol, T. W. (2008) · CHEST Journal · doi:10.1378/chest.07-1631 · Cited by 238 · see citing works
Quality-of-Life Determinants in Patients With Clinically Stable Bronchiectasis
Martínez‐García, M. Á., Perpiñá-Tordera, M., Román-Sánchez, P., & Soler‐Cataluña, J. J. (2005) · CHEST Journal · doi:10.1378/chest.128.2.739 · Cited by 208 · see citing works
A pilot study of low-dose erythromycin in bronchiectasis
Tsang, K., Ho, P., Chan, K., Ip, M., Lam, W. K., Ho, C., Yuen, K., Ooi, G., Amitani, R., & Tanaka, E. (1999) · European Respiratory Journal · doi:10.1183/09031936.99.13236199 · Cited by 196 · see citing works
Reinert, R. R., Reinert, S., van der Linden, M., Cil, M. Y., Al‐Lahham, A., & Appelbaum, P. C. (2005) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.49.7.2903-2913.2005 · Cited by 164 · see citing works
Koh, Y., Lee, M., Sun, Y., Sung, K., & Chae, J. (1997) · European Respiratory Journal · doi:10.1183/09031936.97.10050994 · Cited by 141 · see citing works
Trends in bronchiectasis mortality in England and Wales
Roberts, H. J., & Hubbard, R. (2010) · Respiratory Medicine · doi:10.1016/j.rmed.2010.02.022 · Cited by 115 · see citing works
Yalçın, E., Ki̇per, N., Özçelik, U., Doğru, D., Fırat, P., Sahin, A., Ariyurek, M. O., Mocan, G., Gürcan, N., & Göçmen, A. (2006) · Journal of Clinical Pharmacy and Therapeutics · doi:10.1111/j.1365-2710.2006.00708.x · Cited by 108 · see citing works
Relationship between respiratory symptoms and medical treatment in exacerbations of COPD
Calverley, P. M. A., Pauwels, R., Lofdahl, C., Svensson, K., Higenbottam, T., Carlsson, L., & Ståhl, E. (2005) · European Respiratory Journal · doi:10.1183/09031936.05.00143404 · Cited by 103 · see citing works
Exacerbations in cystic fibrosis: 4 {middle dot} Non-cystic fibrosis bronchiectasis
Chang, A. B., & Bilton, D. (2008) · Thorax · doi:10.1136/thx.2006.060913 · Cited by 96 · see citing works
Altenburg, J., de Graaff, C. S., van der Werf, T. S., & Boersma, W. G. (2010) · Respiration · doi:10.1159/000320320 · Cited by 78 · see citing works
Cai, Y., Chai, D., Wang, R., Bai, N., Liang, B., & Liu, Y.-N. (2011) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkr040 · Cited by 64 · see citing works
Bronchiectasis: CT/clinical correlations
McGuinness, G., & Naidich, D. P. (1995) · Seminars in Ultrasound CT and MRI · doi:10.1016/0887-2171(95)90028-4 · Cited by 33 · see citing works
Trends In Bronchiectasis Among Medicare Beneficiaries In The United States, 2000-2007
Seitz, A. E., Olivier, K. N., Adjemian, J., Holland, S. M., & Prevots, D. R. (2011) · doi:10.1164/ajrccm-conference.2011.183.1_meetingabstracts.a4869 · Cited by 32 · see citing works
Azithromycin therapy for neutrophilic airways disease: myth or magic?
Idris, S. F., Chilvers, E. R., HAWORTH, C. S., McKeon, D. J., & Condliffe, A. M. (2009) · Thorax · doi:10.1136/thx.2008.103192 · Cited by 31 · see citing works
Altenburg, J., de Graaff, C., van der Werf, T. S., & Boersma, W. G. (2011) · European Respiratory Journal · doi:10.1183/13993003/erj.38.suppl_55.1924 · Cited by 8 · see citing works
The Bronchiectasis And Low-Dose Erythromycin Study (BLESS)
Serisier, D. J., Bowler, S., McGuckin, M. A., Chen, A. C. –., Lourie, R., & Martin, M. L. (2012) · doi:10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a6862 · Cited by 5 · see citing works
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European Respiratory Society guidelines for the management of adult bronchiectasis
Polverino, E., Goeminne, P., McDonnell, M. J., Aliberti, S., Marshall, S. E., Loebinger, M. R., Murris, M., Cantón, R., Torres, A., Dimakou, K., et al. (2017) · European Respiratory Journal · doi:10.1183/13993003.00629-2017 · Cited by 1,337 · see citing works
The bronchiectasis severity index. An international derivation and validation study
Chalmers, J. D., Goeminne, P., Aliberti, S., McDonnell, M. J., Lonni, S., Davidson, J., Poppelwell, L., Salih, W., Pesci, A., Dupont, L. J., et al. (2014) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201309-1575oc · Cited by 1,093 · see citing works
International Consensus Document (ICON): Common Variable Immunodeficiency Disorders
Bonilla, F. A., Barlan, I. B., Chapel, H. M., Costa‐Carvalho, B. T., Cunningham‐Rundles, C., de la Morena, M. T., Espinosa-Rosales, F. J., Hammarström, L. L. G., Nonoyama, S., Quinti, I., et al. (2015) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2015.07.025 · Cited by 876 · see citing works
Giovino, G. A., Mirza, S. A., Samet, J. M., Gupta, P. C., Jarvis, M. J., Bhala, N., Peto, R., Zatonski, W., Hsia, J., Morton, J., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61085-x · Cited by 740 · see citing works
Azithromycin: Mechanisms of action and their relevance for clinical applications
Parnham, M. J., Haber, V. E., Giamarellos‐Bourboulis, E. J., Perletti, G., Verleden, G. M., & Vos, R. (2014) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2014.03.003 · Cited by 662 · see citing works
British Thoracic Society Guideline for bronchiectasis in adults
Hill, A. T., Sullivan, A., Chalmers, J. D., Soyza, A. D., Elborn, J. S., Floto, R. A., Grillo, L. J., Gruffydd‐Jones, K., Harvey, A., HAWORTH, C. S., et al. (2018) · Thorax · doi:10.1136/thoraxjnl-2018-212463 · Cited by 638 · see citing works
The role of the microbiome in exacerbations of chronic lung diseases
Dickson, R. P., Martinez, F. J., & Huffnagle, G. B. (2014) · The Lancet · doi:10.1016/s0140-6736(14)61136-3 · Cited by 495 · see citing works
Altenburg, J., de Graaff, C. S., Stienstra, Y., Sloos, J. H., van Haren, E. H. J., Koppers, R. J. H., van der Werf, T. S., & Boersma, W. G. (2013) · JAMA · doi:10.1001/jama.2013.1937 · Cited by 516 · see citing works
Knowles, M. R., Daniels, L. A., Davis, S. D., Zariwala, M. A., & Leigh, M. W. (2013) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201301-0059ci · Cited by 513 · see citing works
Brusselle, G., VanderStichele, C., Jordens, P., Deman, R., Slabbynck, H., Ringoet, V., Verleden, G. M., Demedts, I., Verhamme, K. M. C., Delporte, A., et al. (2013) · Thorax · doi:10.1136/thoraxjnl-2012-202698 · Cited by 477 · see citing works
The microbiome and critical illness
Dickson, R. P. (2016) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(15)00427-0 · Cited by 460 · see citing works
Lung microbiome: new insights into the pathogenesis of respiratory diseases
Li, R., Li, J., & Zhou, X. (2024) · Signal Transduction and Targeted Therapy · doi:10.1038/s41392-023-01722-y · Cited by 466 · see citing works
Pulmonary exacerbation in adults with bronchiectasis: a consensus definition for clinical research
Hill, A. T., HAWORTH, C. S., Aliberti, S., BARKER, A. R., Blasi, F., Boersma, W. G., Chalmers, J. D., Soyza, A. D., Dimakou, K., Elborn, J. S., et al. (2017) · European Respiratory Journal · doi:10.1183/13993003.00051-2017 · Cited by 442 · see citing works
Serisier, D. J., Martin, M. L., McGuckin, M. A., Lourie, R., Chen, A. C. –., Brain, B., Biga, S., Schlebusch, S., Dash, P., & Bowler, S. (2013) · JAMA · doi:10.1001/jama.2013.2290 · Cited by 419 · see citing works
Wallmeier, J., Nielsen, K. G., Kuehni, C. E., Lucas, J. S., Leigh, M. W., Zariwala, M. A., & Omran, H. (2020) · Nature Reviews Disease Primers · doi:10.1038/s41572-020-0209-6 · Cited by 403 · see citing works
Non–Cystic Fibrosis Bronchiectasis
McShane, P. J., Naureckas, E. T., Tino, G., & Strek, M. E. (2013) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201303-0411ci · Cited by 390 · see citing works
Chalmers, J. D., Chang, A. B., Chotirmall, S. H., Dhar, R., & McShane, P. J. (2018) · Nature Reviews Disease Primers · doi:10.1038/s41572-018-0042-3 · Cited by 366 · see citing works
Tunney, M. M., Einarsson, G. G., Wei, L., Drain, M., Klem, E. R., Cardwell, C., Ennis, M., Boucher, R. C., Wolfgang, M. C., & Elborn, J. S. (2013) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201210-1937oc · Cited by 316 · see citing works
Gut-Lung Axis: The Microbial Contributions and Clinical Implications
He, Y., Wen, Q., Yao, F., Xu, D., Huang, Y., & Wang, J. (2017) · Critical Reviews in Microbiology · doi:10.1080/1040841x.2016.1176988 · Cited by 301 · see citing works
The Immunomodulatory Effects of Macrolides—A Systematic Review of the Underlying Mechanisms
Zimmermann, P., Ziesenitz, V. C., Curtis, N. C., & Ritz, N. (2018) · Frontiers in Immunology · doi:10.3389/fimmu.2018.00302 · Cited by 308 · see citing works
Uzun, S., Djamin, R. S., Kluytmans, J. A. J. W., Mulder, P. G. H., Veer, N. E. V. ‘., Ermens, A. A. M., Pelle, A. J. M., Hoogsteden, H. C., Aerts, J. G. J. V., & van der Eerden, M. M. (2014) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(14)70019-0 · Cited by 294 · see citing works
Management of bronchiectasis in adults
Chalmers, J. D., Aliberti, S., & Blasi, F. (2015) · European Respiratory Journal · doi:10.1183/09031936.00119114 · Cited by 290 · see citing works
Knowles, M. R., Zariwala, M. A., & Leigh, M. W. (2016) · Clinics in Chest Medicine · doi:10.1016/j.ccm.2016.04.008 · Cited by 274 · see citing works
Inhaled Colistin in Patients with Bronchiectasis and Chronic Pseudomonas aeruginosa Infection
HAWORTH, C. S., Foweraker, J. E., Wilkinson, P., Kenyon, R. F., & Bilton, D. (2014) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201312-2208oc · Cited by 263 · see citing works
Araújo, D., Shteinberg, M., Aliberti, S., Goeminne, P., Hill, A. T., Fardon, T. C., Obradović, D., Stone, G. A., Trautmann, M., Davis, A., et al. (2018) · European Respiratory Journal · doi:10.1183/13993003.01953-2017 · Cited by 261 · see citing works
Serisier, D. J., Bilton, D., Soyza, A. D., Thompson, P. J., Kolbe, J., Greville, H. W., Cipolla, D. C., Bruinenberg, P., Gonda, I., & the ORBIT-2 investigators (2013) · Thorax · doi:10.1136/thoraxjnl-2013-203207 · Cited by 249 · see citing works
Keir, H. R., Shoemark, A., Dicker, A., Perea, L., Pollock, J. S., Giam, Y. H., Suárez-Cuartín, G., Crichton, M. L., Lonergan, M. E., Oriano, M., et al. (2021) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(20)30504-x · Cited by 248 · see citing works
Dhar, R., Singh, S., Talwar, D., Mohan, M., V, Tripathi, S. K., Swarnakar, R., Trivedi, S., Rajagopala, S., D′Souza, G., Padmanabhan, A., et al. (2019) · The Lancet Global Health · doi:10.1016/s2214-109x(19)30327-4 · Cited by 247 · see citing works
Co‐morbidities in severe asthma: <scp>C</scp> linical impact and management
Porsbjerg, C., & Menzies‐Gow, A. (2017) · Respirology · doi:10.1111/resp.13026 · Cited by 233 · see citing works
Barker, A. F., O’Donnell, A. E., Flume, P. A., Thompson, P. J., Ruzi, J. D., de Gracia, J., Boersma, W. G., Soyza, A. D., Shao, L., Zhang, J., et al. (2014) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(14)70165-1 · Cited by 220 · see citing works
Mortality in non-cystic fibrosis bronchiectasis: A prospective cohort analysis
Goeminne, P., Nawrot, T. S., Ruttens, D., Seys, S., & Dupont, L. (2014) · Respiratory Medicine · doi:10.1016/j.rmed.2013.12.015 · Cited by 216 · see citing works
HAWORTH, C. S., Bilton, D., Chalmers, J. D., Davis, A., Froehlich, J., Gonda, I., Thompson, B., Wanner, A., & O’Donnell, A. E. (2019) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(18)30427-2 · Cited by 215 · see citing works
Aliberti, S., Masefield, S. C., Polverino, E., Soyza, A. D., Loebinger, M. R., Menéndez, R., Ringshausen, F. C., Vendrell, M., Powell, P., & Chalmers, J. D. (2016) · European Respiratory Journal · doi:10.1183/13993003.01888-2015 · Cited by 211 · see citing works
Bronchiectasis: new therapies and new perspectives
Chalmers, J. D., & Chotirmall, S. H. (2018) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(18)30053-5 · Cited by 208 · see citing works
Predicting high risk of exacerbations in bronchiectasis: the E-FACED score
Martínez‐García, M. Á., Athanazio, R. A., Girón, R. M., Máiz‐Carro, L., de la Rosa, D., Olveira, C., de Gracia, J., Vendrell, M., Prados‐Sánchez, C., Gramblicka, G., et al. (2017) · International Journal of COPD · doi:10.2147/copd.s121943 · Cited by 208 · see citing works
Mirra, V., Werner, C., & Santamaria, F. (2017) · Frontiers in Pediatrics · doi:10.3389/fped.2017.00135 · Cited by 208 · see citing works
Mechanisms of immune dysfunction and bacterial persistence in non-cystic fibrosis bronchiectasis
Chalmers, J. D., & Hill, A. T. (2012) · Molecular Immunology · doi:10.1016/j.molimm.2012.09.011 · Cited by 200 · see citing works
Treatment options in type-2 low asthma
Hinks, T., Levine, S. J., & Brusselle, G. (2020) · European Respiratory Journal · doi:10.1183/13993003.00528-2020 · Cited by 193 · see citing works
Chalmers, J. D., Boersma, W. G., Lonergan, M. E., Jayaram, L., Crichton, M. L., Karalus, N., Taylor, S., Martin, M. L., Burr, L. D., Wong, C., et al. (2019) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(19)30191-2 · Cited by 191 · see citing works
Valery, P. C., Morris, P. S., Byrnes, C. A., Grimwood, K., Torzillo, P. J., Bauert, P., Masters, I. B., Diaz, A., McCallum, G. B., Mobberley, C., et al. (2013) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(13)70185-1 · Cited by 189 · see citing works
Rogers, G. B., Bruce, K. D., Martin, M. L., Burr, L. D., & Serisier, D. J. (2014) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(14)70213-9 · Cited by 217 · see citing works
Developments in the diagnosis and treatment of allergic bronchopulmonary aspergillosis
Agarwal, R., Sehgal, I. S., Dhooria, S., & Aggarwal, A. N. (2016) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2016.1249853 · Cited by 174 · see citing works
Ringshausen, F. C., Roux, A. D., Pletz, M. W., Hämäläinen, N., Welte, T., & Rademacher, J. (2013) · PLoS ONE · doi:10.1371/journal.pone.0071109 · Cited by 168 · see citing works
Spanish Guidelines on Treatment of Bronchiectasis in Adults
Martínez‐García, M. Á., Máiz, L., Olveira, C., Girón, R. M., de la Rosa, D., Blanco, M., Cantón, R., Vendrell, M., Polverino, E., de Gracia, J., et al. (2017) · Archivos de Bronconeumología · doi:10.1016/j.arbr.2017.07.014 · Cited by 164 · see citing works
Normativa sobre el tratamiento de las bronquiectasias en el adulto
Martínez‐García, M. Á., Máiz, L., Olveira, C., Girón, R. M., de la Rosa, D., Blanco, M., Cantón, R., Vendrell, M., Polverino, E., de Gracia, J., et al. (2017) · Archivos de Bronconeumología · doi:10.1016/j.arbres.2017.07.016 · Cited by 157 · see citing works
Kobbernagel, H. E., Buchvald, F. F., Haarman, E. G., Casaulta, C., Collins, S. A., Hogg, C. L., Kuehni, C. E., Lucas, J. S., Moser, C. E., Quittner, A. L., et al. (2020) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(20)30058-8 · Cited by 150 · see citing works
Long-term macrolide treatment for chronic respiratory disease
Spagnolo, P., Fabbri, L. M., & Bush, A. (2012) · European Respiratory Journal · doi:10.1183/09031936.00136712 · Cited by 145 · see citing works
Serisier, D. J. (2013) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(13)70038-9 · Cited by 145 · see citing works
Macrolide antibiotics for bronchiectasis
Kelly, C. A., Chalmers, J. D., Crossingham, I. R., Relph, N., Felix, L. M., Evans, D. J., Milan, S. J., & Spencer, S. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012406.pub2 · Cited by 137 · see citing works
Adverse events in people taking macrolide antibiotics versus placebo for any indication
Hansen, M. P., Scott, A. M., McCullough, A. R., Thorning, S., Aronson, J. K., Beller, E., Glasziou, P., Hoffmann, T., Clark, J. M., & Mar, C. D. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011825.pub2 · Cited by 138 · see citing works
Wilkinson, M., Sugumar, K., Milan, S. J., Hart, A., Crockett, A. J., & Crossingham, I. R. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001289.pub2 · Cited by 135 · see citing works
Lai, K., Shen, H., Zhou, X., Qiu, Z., Shaoxi, C., Huang, K., Wang, Q., Wang, C., Lin, J., Hao, C., et al. (2018) · Journal of Thoracic Disease · doi:10.21037/jtd.2018.09.153 · Cited by 133 · see citing works
The immunomodulatory effects of macrolide antibiotics in respiratory disease
Pollock, J. S., & Chalmers, J. D. (2021) · Pulmonary Pharmacology & Therapeutics · doi:10.1016/j.pupt.2021.102095 · Cited by 133 · see citing works
Blood, Tissue, and Intracellular Concentrations of Azithromycin during and after End of Therapy
Matzneller, P., Krasniqi, S., Kinzig, M., Sörgel, F., Hüttner, S., Lackner, E., Müller, M., & Zeitlinger, M. A. (2013) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.02011-12 · Cited by 131 · see citing works
Current and Future Treatments in Primary Ciliary Dyskinesia
Paff, T., Omran, H., Nielsen, K. G., & Haarman, E. G. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22189834 · Cited by 128 · see citing works
COPD-related Bronchiectasis; Independent Impact on Disease Course and Outcomes
Gatheral, T. L., Kumar, N., Sansom, B., Lai, D., Nair, A., Vlahos, I., & Baker, E. H. (2014) · COPD Journal of Chronic Obstructive Pulmonary Disease · doi:10.3109/15412555.2014.922174 · Cited by 125 · see citing works
Bronchiectasis management in adults: state of the art and future directions
Choi, H., McShane, P. J., Aliberti, S., & Chalmers, J. D. (2024) · European Respiratory Journal · doi:10.1183/13993003.00518-2024 · Cited by 118 · see citing works
Nontuberculous mycobacterial (NTM) lung disease: The top ten essentials
Aksamit, T. R., Philley, J. V., & Griffith, D. E. (2013) · Respiratory Medicine · doi:10.1016/j.rmed.2013.09.014 · Cited by 117 · see citing works
Azithromycin suppresses CD4+ T-cell activation by direct modulation of mTOR activity
Ratzinger, F., Haslacher, H., Poeppl, W., Hoermann, G., Kovarik, J. J., Jutz, S., Steinberger, P., Burgmann, H., Pickl, W. F., & Schmetterer, K. G. (2014) · Scientific Reports · doi:10.1038/srep07438 · Cited by 113 · see citing works
Comorbidities in interstitial lung diseases
Margaritopoulos, G. A., Antoniou, K. M., & Wells, A. U. (2017) · European Respiratory Review · doi:10.1183/16000617.0027-2016 · Cited by 115 · see citing works
Bronchiectasis: Current Concepts in Pathogenesis, Immunology, and Microbiology
Boyton, R. J., & Altmann, D. M. (2016) · Annual Review of Pathology Mechanisms of Disease · doi:10.1146/annurev-pathol-012615-044344 · Cited by 112 · see citing works
The role of macrolides in asthma: current evidence and future directions
Wong, E., Porter, J. D., Edwards, M. R., & Johnston, S. L. (2014) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(14)70107-9 · Cited by 110 · see citing works
Nonantibiotic Effects of Fluoroquinolones in Mammalian Cells
Badal, S., Her, Y. F., & Maher, L. J. (2015) · Journal of Biological Chemistry · doi:10.1074/jbc.m115.671222 · Cited by 109 · see citing works
The biology of pulmonary exacerbations in bronchiectasis
Amati, F., Simonetta, E., Gramegna, A., Tarsia, P., Contarini, M., Blasi, F., & Aliberti, S. (2019) · European Respiratory Review · doi:10.1183/16000617.0055-2019 · Cited by 103 · see citing works
Lin, J., Xu, J., & Qu, J. (2016) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201511-740ps · Cited by 100 · see citing works
Cramer‐Bour, C., Patterson, A., Alchakaki, A., & Soubani, A. O. (2017) · Postgraduate Medicine · doi:10.1080/00325481.2017.1285677 · Cited by 99 · see citing works
McMullan, B. J., & Mostaghim, M. (2015) · Australian Prescriber · doi:10.18773/austprescr.2015.030 · Cited by 99 · see citing works
Lung disease in primary antibody deficiency
Verma, N., Grimbacher, B., & Hurst, J. R. (2015) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(15)00202-7 · Cited by 96 · see citing works
Antibiotic Prophylaxis in Primary Immune Deficiency Disorders
Kuruvilla, M. E., & de la Morena, M. T. (2013) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2013.09.013 · Cited by 96 · see citing works
Li, H., Liu, D., Chen, L., Zhao, Q., Yu, Y., Ding, J., Miao, L., Xiao, Y., Cai, H., Zhang, D., et al. (2013) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.02067-13 · Cited by 96 · see citing works
Dhalla, F., Lucas, M., Schuh, A., Bhole, M. V., Jain, R., Patel, S. Y., Misbah, S., & Chapel, H. M. (2014) · Journal of Clinical Immunology · doi:10.1007/s10875-014-9995-5 · Cited by 96 · see citing works
Chalmers, J. D., McHugh, B. J., Doherty, C. J., Smith, M. P., Govan, J. R. W., Kilpatrick, D. C., & Hill, A. T. (2013) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(13)70001-8 · Cited by 94 · see citing works
Simpson, J. L., Powell, H. A., Baines, K. J., Milne, D. G., Coxson, H. O., Hansbro, P. M., & Gibson, P. G. (2014) · PLoS ONE · doi:10.1371/journal.pone.0105609 · Cited by 94 · see citing works
Atorvastatin as a stable treatment in bronchiectasis: a randomised controlled trial
Mandal, P., Chalmers, J. D., Graham, C., Harley, C., Sidhu, M., Doherty, C. J., Govan, J. R. W., Sethi, T., Davidson, D. J., Rossi, A. G., et al. (2014) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(14)70050-5 · Cited by 93 · see citing works
Milito, C., Pulvirenti, F., Cinetto, F., Lougaris, V., Soresina, A., Pecoraro, A., Vultaggio, A., Carrabba, M., Lassandro, G., Plebani, A., et al. (2019) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2019.01.051 · Cited by 90 · see citing works
Primary ciliary dyskinesia (PCD): A genetic disorder of motile cilia
Leigh, M. W., Horani, A., Kinghorn, B., O’Connor, M. G., Zariwala, M. A., & Knowles, M. R. (2019) · Translational Science of Rare Diseases · doi:10.3233/trd-190036 · Cited by 90 · see citing works
Nonantimicrobial Actions of Macrolides: Overview and Perspectives for Future Development
Kricker, J. A., Page, C. P., Gardarsson, F. R., Baldursson, Ó., Guðjónsson, Þ., & Parnham, M. J. (2021) · Pharmacological Reviews · doi:10.1124/pharmrev.121.000300 · Cited by 92 · see citing works
Chmiel, J., Aksamit, T., Chotirmall, S. H., Dasenbrook, E., Elborn, J., Lipuma, J., Ranganathan, S., Waters, V., & Ratjen, F. (2014) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201405-203as · Cited by 89 · see citing works
Interventions for bronchiectasis: an overview of Cochrane systematic reviews
Welsh, E. J., Evans, D. J., Fowler, S. J., & Spencer, S. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010337.pub2 · Cited by 88 · see citing works
Lung Disease in Primary Antibody Deficiencies
Schussler, E., Beasley, M. B., & Maglione, P. J. (2016) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2016.08.005 · Cited by 87 · see citing works
Gillis, D., & Riminton, S. (2011) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2011.tb03789.x · Cited by 89 · see citing works
Treatment of Slowly Growing Mycobacteria
Philley, J. V., & Griffith, D. E. (2014) · Clinics in Chest Medicine · doi:10.1016/j.ccm.2014.10.005 · Cited by 86 · see citing works
Pseudomonas aeruginosa in bronchiectasis: infection, inflammation, and therapies
Vidaillac, C., & Chotirmall, S. H. (2021) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2021.1906225 · Cited by 86 · see citing works
Antibiotics for treatment and prevention of exacerbations of chronic obstructive pulmonary disease
Wilson, R., Sethi, S., Anzueto, A., & Miravitlles, M. (2013) · Journal of Infection · doi:10.1016/j.jinf.2013.08.010 · Cited by 85 · see citing works
The heterogeneity of systemic inflammation in bronchiectasis
Saleh, A., Chalmers, J. D., Soyza, A. D., Fardon, T. C., Koustas, S. O., Scott, J., Simpson, A. J., Brown, J., & Hurst, J. R. (2017) · Respiratory Medicine · doi:10.1016/j.rmed.2017.04.009 · Cited by 81 · see citing works
Lobo, J., Zariwala, M., & Noone, P. G. (2015) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/s-0035-1546748 · Cited by 81 · see citing works
Challenges in managing Pseudomonas aeruginosa in non-cystic fibrosis bronchiectasis
Wilson, R. C., Aksamit, T. R., Aliberti, S., Soyza, A. D., Elborn, J. S., Goeminne, P., Hill, A. T., Menéndez, R., & Polverino, E. (2016) · Respiratory Medicine · doi:10.1016/j.rmed.2016.06.007 · Cited by 81 · see citing works
Neutrophilic inflammation in bronchiectasis
Chalmers, J. D., Metersky, M. L., Aliberti, S., Morgan, L. C., Fucile, S., LAUTERIO, M., & McDonald, P. P. (2025) · European Respiratory Review · doi:10.1183/16000617.0179-2024 · Cited by 79 · see citing works
Brill, S., Patel, A. R. C., Singh, R., Mackay, A. J., Brown, J., & Hurst, J. R. (2015) · Respiratory Research · doi:10.1186/s12931-015-0167-9 · Cited by 77 · see citing works
Hare, K. M., Singleton, R. J., Grimwood, K., Valery, P. C., Cheng, A. C., Morris, P. S., Leach, A. J., Smith‐Vaughan, H., Chatfield, M. D., Redding, G. J., et al. (2013) · PLoS ONE · doi:10.1371/journal.pone.0070478 · Cited by 73 · see citing works
Clinical care of children with primary ciliary dyskinesia
Lucas, J. S., Alanin, M. C., Collins, S. A., Harris, A. L., Johansen, H. K., Nielsen, K. G., Papon, J., Robinson, P. J., & Walker, W. T. (2017) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2017.1360770 · Cited by 73 · see citing works
Long‐term macrolides for non‐cystic fibrosis bronchiectasis: A systematic review and meta‐analysis
Wu, Q., Shen, W., Cheng, H., & Zhou, X. (2014) · Respirology · doi:10.1111/resp.12233 · Cited by 72 · see citing works
Watz, H., Nagelschmitz, J., Kirsten, A., Pedersen, F., van der Mey, D., Schwers, S., Bandel, T.-J., & Rabe, K. F. (2019) · Pulmonary Pharmacology & Therapeutics · doi:10.1016/j.pupt.2019.03.009 · Cited by 72 · see citing works
Goeminne, P., Cox, B., Finch, S., Loebinger, M. R., Bedi, P., Hill, A. T., Fardon, T. C., de Hoogh, K., Nawrot, T. S., & Chalmers, J. D. (2018) · European Respiratory Journal · doi:10.1183/13993003.02557-2017 · Cited by 70 · see citing works
Long-term macrolide maintenance therapy in non-CF bronchiectasis: Evidence and questions
HAWORTH, C. S., Bilton, D., & Elborn, J. S. (2014) · Respiratory Medicine · doi:10.1016/j.rmed.2014.09.005 · Cited by 70 · see citing works
Ringshausen, F. C., Apel, R.-M., Bange, F., Roux, A. D., Pletz, M. W., Rademacher, J., Suhling, H., Wagner, D., & Welte, T. (2013) · BMC Infectious Diseases · doi:10.1186/1471-2334-13-231 · Cited by 70 · see citing works
The Efficacy and Safety of Inhaled Antibiotics for the Treatment of Bronchiectasis in Adults
Cordeiro, R. J. P. D. M., Choi, H., HAWORTH, C. S., & Chalmers, J. D. (2024) · CHEST Journal · doi:10.1016/j.chest.2024.01.045 · Cited by 69 · see citing works
Bronchiectasis in severe asthma
Coman, I., Pola-Bibian, B., Barranco, P., Vilà-Nadal, G., Domínguez‐Ortega, J., Romero, D., Villasante, C., & Quirce, S. (2018) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2018.02.016 · Cited by 69 · see citing works
Smith, D., Rand, I. D., Addy, C., Collyns, T. A., Hart, S. P., Mitchelmore, P. J., Rahman, N. M., & Saggu, R. (2020) · Thorax · doi:10.1136/thoraxjnl-2019-213929 · Cited by 69 · see citing works
The Lung Immune Response to NontypeableHaemophilus influenzae(Lung Immunity to NTHi)
King, P. T., & Sharma, R. (2015) · Journal of Immunology Research · doi:10.1155/2015/706376 · Cited by 68 · see citing works
- Authors
- Wong, C., Jayaram, L., Karalus, N., Eaton, T., Tong, C., Hockey, H., Milne, D., Fergusson, W., Tuffery, C., Sexton, P., Storey, L., & Ashton, T.
- Affiliations
- Middlemore Hospital (NZ)
- Monash Medical Centre (AU)
- Waikato Hospital (NZ)
- Auckland City Hospital (NZ)
- University of Auckland (NZ)
- Corresponding author
- Wong, Conroy
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2012-08
- Volume
- 380
- Issue
- 9842
- Pages
- 660-667
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2169216429
- Cited by
- 600
- References
- 38
- Citations by year
- 2026: 33 · 2025: 22 · 2024: 29 · 2023: 21 · 2022: 33 · 2021: 36 · 2020: 37 · 2019: 48 · 2018: 56 · 2017: 59 · 2016: 45 · 2015: 52 · 2014: 67 · 2013: 55 · 2012: 6
- FWCI
- 46.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cystic Fibrosis Research Advances
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Epidemiology › Mycobacterium research and diagnosis
- Keywords
- azithromycin, non-cystic fibrosis bronchiectasis, pulmonary exacerbations, macrolide antibiotics, anti-inflammatory therapy, lung function, health-related quality of life, St George's Respiratory Questionnaire, FEV1, EMBRACE trial, antibiotic prophylaxis, immunomodulation, adverse events
- MeSH terms
- Adult, Aged, Anti-Bacterial Agents, Bronchiectasis, Cystic Fibrosis, Double-Blind Method, Drug Administration Schedule, Female, Forced Expiratory Volume, Humans, Male, Middle Aged, Quality of Life, Vital Capacity, Treatment Outcome, Azithromycin, Secondary Prevention
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