A Cochrane review [Abstract] 1 included 7 studies with a total of 416 subjects. Studies compared macrolide treatment for at least 4 weeks in adult and pediatric patients treated for chronic asthma. The methodological quality was generally low. There was no significant difference in FEV1 for either parallel or crossover trials. However, there were positive effects on symptoms (SMD -1.25, 95% CI -1.80 to -0.70) and markers of eosinophilic inflammation. One large parallel group trial reported significant differences in peak flow at 6 weeks (6 l/min for am PEF and 8 l/min for pm PEF), but these differences abated within six months of treatment.
The authors conclude that even though some clinical data indicate a positive effect of macrolides in asthmatic patients in the absence of relevant side effects, these data are insufficient to recommend the routine use of macrolides for control of asthma at present.
Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals) and by study quality (only one study had a Jadad score of 3, the other studies scored less).
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