0
Correspondence |

Response FREE TO VIEW

Adam L. Friedlander, MD; Richard K. Albert, MD, FCCP
Author and Funding Information

From the Division of Pulmonary Sciences and Critical Care Medicine (Drs Friedlander and Albert), and the Department of Medicine, Denver Health (Dr Albert), Department of Medicine, University of Colorado Denver Health Sciences Center; and the Department of Medicine (Dr Friedlander), National Jewish Health.

Correspondence to: Adam L. Friedlander, MD, National Jewish Health, 1400 Jackson St, Denver, CO 80206; e-mail: Adam.Friedlander@UCDenver.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Albert has received National Institutes of Health funding to study macrolides in COPD. Dr Friedlander has reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(5):1247. doi:10.1378/chest.10-3294
Text Size: A A A
Published online

To the Editor:

We thank Dr Vos and colleagues for providing important additional studies that support the use of long-term azithromycin therapy to treat and, possibly, prevent posttransplant bronchiolitis obliterans syndrome (BOS). These studies should have been included in our review of chronic macrolide therapy in inflammatory airways disease1 but were not available at the time of submission.

Their recently published retrospective observational study2 is the largest to date and confirms previous findings that a dichotomy exists in the clinical spectrum of BOS, with neutrophilic allograft dysfunction being macrolide responsive, whereas fibroproliferative BOS is not. Importantly, their study supports the finding observed by Jain et al3 showing better long-term survival in responders compared with nonresponders. Given these more recent studies, we wish to change our grading recommendation to 2A in favor of the use of long-term azithromycin therapy in a subgroup of patients with established BOS (neutrophilic).

We believe that the recently published randomized controlled trial of azithromycin prophylaxis in lung transplant recipients by Vos et al4 is the first to demonstrate that long-term macrolide therapy may prevent BOS. Additionally, this study supports the immunomodulatory effects seen with certain macrolides therapy, even when given at low doses, as discussed in our review. We agree that this is good evidence supporting the use of long-term, low-dose azithromycin therapy to prevent BOS. However, additional placebo-controlled randomized trials are necessary to further define the potential adverse effects of this therapy.

Friedlander AL, Albert RK. Chronic macrolide therapy in inflammatory airways diseases. Chest. 2010;1385:1202-1212. [CrossRef] [PubMed]
 
Vos R, Vanaudenaerde BM, Ottevaere A, et al. Long-term azithromycin therapy for bronchiolitis obliterans syndrome: divide and conquer? J Heart Lung Transplant. 2010;2912:1358-1368. [CrossRef] [PubMed]
 
Jain R, Hachem RR, Morrell MR, et al. Azithromycin is associated with increased survival in lung transplant recipients with bronchiolitis obliterans syndrome. J Heart Lung Transplant. 2010;295:531-537. [CrossRef] [PubMed]
 
Vos R, Vanaudenaerde BM, Verleden SE, et al. A randomized placebo-controlled trial of azithromycin to prevent chronic rejection after lung transplantation. Eur Respir J. 2011;371:164-172. [CrossRef] [PubMed]
 

Figures

Tables

References

Friedlander AL, Albert RK. Chronic macrolide therapy in inflammatory airways diseases. Chest. 2010;1385:1202-1212. [CrossRef] [PubMed]
 
Vos R, Vanaudenaerde BM, Ottevaere A, et al. Long-term azithromycin therapy for bronchiolitis obliterans syndrome: divide and conquer? J Heart Lung Transplant. 2010;2912:1358-1368. [CrossRef] [PubMed]
 
Jain R, Hachem RR, Morrell MR, et al. Azithromycin is associated with increased survival in lung transplant recipients with bronchiolitis obliterans syndrome. J Heart Lung Transplant. 2010;295:531-537. [CrossRef] [PubMed]
 
Vos R, Vanaudenaerde BM, Verleden SE, et al. A randomized placebo-controlled trial of azithromycin to prevent chronic rejection after lung transplantation. Eur Respir J. 2011;371:164-172. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543