TY - JOUR T1 - Hot Topics from the Assemblies JF - Breathe JO - Breathe SP - 181 LP - 182 DO - 10.1183/20734735.122316 VL - 12 IS - 2 A2 - , Y1 - 2016/06/01 UR - http://breathe.ersjournals.com/content/12/2/181.abstract N2 - Authors: Stokholm J, Chawes B, Vissing N et al.Lancet Respir Med 2016; 4: 19–26.Summary: Acute, asthma-like episodes in young children are extremely common and are responsible for a high proportion of hospital admissions. It has previously been shown that bacteria and viruses may be aetiological agents for these episodes, but currently antibiotic therapy is not routinely advised.In this double-blind study the investigators assessed the effect of giving azithromycin in these acute asthma-like episodes. Children aged 1–3 years were recruited from the Copenhagen Prospective Studies on Asthma in Childhood 2010 cohort. 158 asthma-like episodes in 72 children were randomly assigned to receive either azithromycin (79 episodes) or placebo (79 episodes) for an episode of asthma-like symptoms lasting at least 3 days.The primary outcome of the study was duration of the acute respiratory episode after treatment, which was 63% shorter for those children receiving azithromycin compared with placebo (95% CI 56.0–69.3%, p<0.0001). If treatment started earlier, the effect size was further increased with an 83% shortening of duration when treatment was started prior to the sixth day of symptoms, compared with a 36% reduction if started on or after the sixth day (p<0.001). There was no significant difference in the treatment effect between episodes where a bacterial pathogen was detected and episodes where no bacteria were detected, suggesting that the potential benefit may be related to anti-inflammatory rather than anti-­bacterial effects.This study shows that there may be a role for treating acute respiratory episodes in young children with macrolide antibiotics, but the exact underlying mechanisms are unclear. Further investigation is required concerning the potential consequences of long-term use of macrolides in children. Particular areas for investigation should be the possible increase in serious cardiac events, as previously associated with … ER -