The impact of azithromycin therapy on the airway microbiota in asthma

Thorax 2014;69:673-674 doi:10.1136/thoraxjnl-2013-204517

• Research letter

1. Mariel Slater1, 
2. Damian W Rivett2, 
3. Lisa Williams3, 
4. Matthew Martin3, 
5. Tim Harrison3,
6. Ian Sayers1, 
7. Kenneth D Bruce4, 
8. Dominick Shaw3

+Author Affiliations

1. ¹Department of Therapeutics and Molecular Medicine, University of Nottingham, Nottingham, UK
2. ²Department of Ecology and Evolution, Imperial College, London, UK
3. ³Department of Respiratory Medicine, University of Nottingham, Nottingham, UK
4. ⁴Institute of Pharmaceutical Science, Kings College London, London, UK

1. Correspondence toDr Kenneth Bruce, King's College London, Molecular Microbiology Research Laboratory, Institute of Pharmaceutical Science, 150 Stamford Street, London SE1 9NH, UK;kenneth.bruce@kcl.ac.uk

• Received 15 September 2013
• Revised 5 November 2013
• Accepted 6 November 2013
• Published Online First 28 November 2013

Introduction

There is interest in the use of macrolide antibiotics in asthma. Macrolides have been shown to improve airway hyper-responsiveness (AHR) and measures of airway inflammation.1 The degree of AHR may relate to the microbiota present in the airways,2 with a recent study reporting that patients with asthma with a significant improvement in AHR following treatment with clarithromycin had a higher bacterial diversity prior to treatment.3 To our knowledge, the impact on the asthmatic airway microbiota of an antibiotic has not been reported and we therefore set out to establish if macrolide therapy was associated with a change in airway microbiota in asthma.

Methods

Five adult patients with moderate/severe asthma (British Thoracic Society step 4–5) (see online supplementary table S1) and no evidence of respiratory infection or bronchiectasis underwent bronchoscopy before and after 6 weeks of daily 250 mg azithromycin therapy. Patients had consented to the study (REC 11/EM/0062). Saline washings of the right upper lobe were obtained following standard procedure, DNA was isolated from the samples (see online supplementary …

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