TY - JOUR T1 - Hot topics from the Assemblies JF - Breathe JO - Breathe SP - 263 LP - 264 DO - 10.1183/20734735.008014 VL - 10 IS - 3 A2 - , Y1 - 2014/09/01 UR - http://breathe.ersjournals.com/content/10/3/263.abstract N2 - Authors: Uzun S, Djamin RS, Kluytmans JAJW, et al. Lancet Respir Med 2014; 2: 361–368 Summary: This study represents a significant development in the use of long-term azithromycin maintenance treatment in a subgroup of patients with chronic obstructive pulmonary disease (COPD). Patients with >3 exacerbations in the preceding year were randomised to receive thrice-weekly placebo or azithromycin treatment. 92 patients were randomised to receive azithromycin (n = 47) or placebo (n = 45) and reviewed every 3 months for 1 year. The primary outcome was rate of exacerbations. The statistically significant reduction in exacerbations in patients treated with azithromycin was sustained after adjustment for covariates. The rate ratio of exacerbations with azithromycin to placebo was 0.58 (95% CI 0.42–0.79; p = 0.001). Median time to first exacerbation was 59 days with placebo (95% CI 31–87) and 130 days with azithromycin (CI 28-232; p = 0.001). The odds ratio for hospital admission did not differ between groups (OR 1.34, 95% CI 0.67–2.70; p = 0.41). In terms of quality-of-life measures (St Georges Respiratory Questionnaire and SF-12) there was a difference in favour of azithromycin at 3 months which was not maintained at 12-month follow up. The most commonly reported side effect of diarrhoea was more prevalent in the azithromycin group (p = 0.015). Fewer patients in the azithromycin group had colonisation with new respiratory pathogens. This study has significant implications for clinical practice. The authors recommend long-term azithromycin treatment in patients with COPD, refractory to standard care, although they caution in favour of monitoring for macrolide resistance. Risks of macrolide resistance and exposure to side effects can be minimised through targeted therapy to this subgroup of patients. Reviewed by: Serena Strickland (UK, Assembly 1) Authors: Yang L1, Yang X, Ji W, et al. Am J Respir Crit Care Med 2014; … ER -