Is Azithromycin Licensed for Asthma Treatment in the UK?

[Matman]

Hi

Does anyone on the Asthma UK Team (or other Professionals reading this) know if the Antibiotic Azithromycin is Licensed in the UK for Asthma Treatment to tackle related bacterial lung infection?

I’m aware that Azithromycin is licensed in the UK for some Repiratory conditions, including some kinds of bronchiectasis.

If Azithromycin is NOT licensed in the UK for Asthma, then is discretionary ‘Off Licence’ Prescribing by UK GPs / Consultants (based on flexibly granted to them by the BMJ) something that occurs: quite often, rarely, never?

I’m asking to try and determine whether, if I ask for it, I’m likely to get it prescribed for my Asthma by either an NHS or Private GP / Consultant.

Have any UK suffers reading this been prescribed Azithromycin for Asthma, if so, was that through the NHS or via a Private Consultant PLUS for what length of time, and with what outcome? (Also, were there any major side effects?).

We’re you prescribe it as part of a clinical trial, or just routinely by your GP or Consultant? Was receiving it conditional on you having any special tests (and which ones)?

Also keen to know what, if any, Macrolide Group Antibiotics in general are licensed for periods of use greater than 2 Weeks for Asthma in the UK?

As always, thanks in advance for your answers, thoughts and comments.

Stay Well

[Samsgran]

I take Azitjromyvin for asthma. Prescribed by a hospital consultant initially but now routinely by my GP

I believe it has kept me infection free for the past year and I am about to have a holiday from it.

[Matman in reply to Samsgran]

Thanks very much for that. Most Appreciated.

Any side effects from the Azithromycin?

Glad to here you’ve been infection free (which I’ve taken to mean coughs, colds etc).

Have you been Asthma Free too? If not, has it improved yourAsthma lots, or just a bit?

BTW which Hospital initially prescribed?

Did you have to have a lung biopsy first?

Thanks Again

[Sylvsmum in reply to Matman]

No side effects that I have noticed at all. Yes, have been infection free but have chronic asthma which means I am never asthma free.

In 2016 I caught an infection called Pseudomonas and I spent more time in hospital with constant infections which required intravenous antibiotics, than I spent at home. My truly wonderful consultant at Royal Berks Hospital, Reading, gave me confidence that I WOULD get better, but it would take a very long time. I used a wheelchair until about September last year but now I feel I am living a more or less 'normal' life and I feel - rightly or wrongly - that it is helped by Azithromycin.

But - it's not all about the drugs, I've done three Pulmonary Rehab courses which encourage exercise - very important even if you don't feel up to it. Now started in a Singing for Lung Health group which is a great deal of fun, socialising (also important) and our leader (trained by the British Lunch Foundation) works us very hard with exercises as well as singing.

Good luck for the future, mine is looking bright.

[Matman in reply to Sylvsmum]

Many thanks. All duly noted. Very useful info.

[Wheezy19543]

Hello,

I take Azithromycin for my asthma prescribed by my tertiary centre as well as my normal consultant. They use it for the anti inflammatory properties.

The only side effect I had was a bad tummy which subsided after a few weeks.

[Matman]

Thanks. Appreciate that.

May I please ask to what extent, if any, do you feel it has contributed to a reduction in your Asthma?

Also, how many Weeks / Months ‘Continuous Use’ have you been advised to take it for? (e.g. A Month, Longer?)

Were you first required to have a Lung Biopsy before Azithromycin was able to be prescribed?

Lastly, as it seems that not all Consultants are as willing as others to prescribe it, may I ask which hospital you attended, as I might look to be referred there.

Thanks again.

[Arniemouse]

Hi I took it for 2 years until about 2 years ago. I had few side effects and it was great remained virtually infection free and asthma was much better too. I was devastated when I realised that it was beginning to affect my hearing and had to stop it as things have not been as stable since. I was prescribed it by a consultant with no special tests required and then continued by my GP with no problems with repeat prescriptions. Hope that helps. Hearing not too bad thankfully but apparently is one of its major long term problems.

[Matman in reply to Arniemouse]

Thanks very much. Very useful insight.

[risabel59]

Hi Matman,

I take Azithromycin 250mg 3 times a week for Asthma & Bronchiectstasis, I believe that it is not licensed for either condition as a treatment , however it is commonly prescribed for both by consultants, I don't think your GP can give it to you long term. Azithro does not work for everyone with Asthma, but seems to have made a big difference to me. I have taken it for 18 months now, and I am the best I have been in 10 years!! I worry that I will develop resistance to it. But my consultant thinks that is unlikely. Apparently Azithro has an Anti-inflammatory effect.

Anyway, I am now not sure that it is the Azithro which has had the positive effect, as I got diagnosed with hook worms, a few weeks ago, (Picked up in the Middle East) and they apparently can damp down the immune system response, which triggers asthma. They did some Human Trials of Hook worms and Asthma in Australia, Not that many people participated, but everyone who got the hook worms, decided to keep the worms at the end of the Trial, apart from one lady who wanted to get Pregnant.

R x

[Matman]

Thanks Risabel. Have added Hook Worms to my list of possibile treatment options

[Clanmacbeath]

Hi. I have been on it for over a year. 3 tablets a week. It was prescribed by my consultant initilly and now my gp. I find on the days when I take it I have a very upset stomach for a few hours. I had hoped that my body would get used to it and that the tummy issues would get better but they haven't. I have chronic asthma which is difficult for manage. My consultant is looking to start me on mepo shortly. As far as the azithro goes it doesn't seem to have any real benefit for me my asthma like many others has been particularly bad this winter.

[Matman]

Thanks Clanmacbeath

[Hidden]

Hi Matman

I had a chat with our clinical lead Dr Whittamore about it. Here's his reply below:

Looking at the licensing and other reference guides I cannot see that azithromycin ( a type of antibiotic called a macrolide) is licensed for use in asthma.

The BTS/SIGN guidelines looked at it, but did not recommend it

A systematic review of the use of macrolides in patients with chronic asthma concluded that they confer no benefit over placebo in terms of clinical outcomes. There was some evidence of possible benefit in improved lung function but concern about the risk of increased antimicrobial resistance. Subgroup analyses in two of the included studies suggested improved outcomes in patients with non-eosinophilic asthma, but patient numbers were small and no conclusions can be drawn from the data available.489 There is insufficient evidence to support the addition of macrolides to existing treatment for patients with severe asthma.

However…. There is growing use of azithromycin in respiratory care, especially asthma…. there was quite a bit of research presented at ERS last year so it will be interesting to see if any guidelines update their guidance. This group of antibiotics seen to have anti-inflammatory properties (as well as anti-infective properties) and are useful in people with certain types of asthma…. especially neutrophilic it seems. It would normally be prescribed in specialist clinics by someone who has investigated the asthma in more detail to see why it is not responding to usual medicines.

Azithromycin for its antibiotic use sometimes happens but there are more commonly prescribed antibiotics used for chest conditions (whether asthma or not). It is licensed for this but the prescriber should base their treatment decision on sensitivities (following eg sputum analysis) or by following locally agreed advice from microbiology team on likely bacteria and best antibiotics for you.

‘Asking for it’ shouldn’t affect the prescriber. If you have a persistent infection then it may be 1. Viral (often yellow sputum) 2. Bacterial (persistently green sputum) (consider a sputum sample) 3. Not an infection ….. undertreated asthma, normal or extra sputum production, other diagnoses.

Hope that helps,

Dita

[Matman in reply to Hidden]

Dita

Thanks to both you and Dr Whittamore for that helpful and detailed reply. Very much appreciated.