The effect of maintenance azithromycin on radiological features in patients with bronchiectasis –Analysis of a randomized controlled trial
Oncology, infection and vascular disease (English)Background: Bronchiectasis (abnormal dilatation of bronchi) is usually diagnosed by high resolution computed tomography (HRCT) and radiological severity has been found to correspond with clinical outcome. A beneficial effect of macrolides maintenance treatment in patients with bronchiectasis and frequent exacerbations has been established in randomized trials. This study was undertaken to prospectively evaluate the effect of long-term azithromycin (AZM) on radiological features in patients with bronchiectasis.
Methods: The Bronchiectasis and long-term Azithromycin Treatment (BAT) randomized controlled trial in the Netherlands (2008-2010) investigated the effect of 1 year of AZM treatment (250 mg OD) in bronchiectasis with frequent exacerbations. Chest (HR)CT-scans at baseline and after one year of study treatment were scored by two radiologists according to the Brody - and the Bhalla scoring system.
Findings: An improvement of the radiological features of patients with bronchiectasis was found after one year of AZM maintenance therapy as compared to placebo for both the Brody and the Bhalla score (p=0.024, p=0.071). Radiological deterioration was seen on the Brody bronchiectasis sub score for the placebo treated patients (mean 14.5 (11.7) respectively 15.7 (11.9) p=0.054). For the AZM-treated patients the Brody sub scores, peribronchial thickening (p=0.035),the parenchyma score (p=0.001) and mucous plugging (p=0.089), improved, with comparable results at the Bhalla sub scores.
Interpretation: The beneficial effect of long-term AZM treatment on radiological features for both the Brody and the Bhalla score was demonstrated in this randomized controlled trial. (HR)CT’s can be used as an objective measure of treatment response in bronchiectasis.