Azithromycin reduces bronchial wall thickening in infants with cystic fibrosis

J Cyst Fibros. 2024 Sep;23(5):870-873. doi: 10.1016/j.jcf.2024.04.001. Epub 2024 Apr 6.

Abstract

Background: COMBAT-CF showed that children aged 0-3 years treated with azithromycin did clinically better than placebo but there was no effect on CT-scores. We reanalysed CTs using an automatic bronchus-artery (BA) analysis.

Method: Inspiratory and expiratory CTs at 12 and 36 months were analysed. BA-analysis measures BA-diameters: bronchial outer wall (Bout), bronchial inner wall (Bin), artery (A), and bronchial wall thickness (Bwt) and computes BA-ratios: Bout/A and Bin/A for bronchial widening, Bwt/A and Bwa/Boa (bronchial wall area/bronchial outer area) for bronchial wall thickening. Low attenuation regions (LAR) were analysed using an automatic method. Mixed-effect model was used to compare BA-outcomes at 36 months between treatment groups.

Results: 228 CTs (59 placebo; 66 azithromycin) were analysed. The azithromycin group had lower Bwa/Boa (p = 0.0034) and higher Bin/A (p = 0.001) relative to placebo. Bout/A (p = 0.0088) was higher because of a reduction in artery diameters which correlated to a reduction in LAR.

Conclusion: Azithromycin-treated infants with CF show a reduction in bronchial wall thickness and possibly a positive effect on lung perfusion.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Anti-Bacterial Agents* / therapeutic use
  • Azithromycin* / administration & dosage
  • Azithromycin* / therapeutic use
  • Bronchi* / diagnostic imaging
  • Bronchi* / drug effects
  • Bronchi* / pathology
  • Child, Preschool
  • Cystic Fibrosis* / complications
  • Cystic Fibrosis* / drug therapy
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Tomography, X-Ray Computed* / methods
  • Treatment Outcome

Substances

  • Azithromycin
  • Anti-Bacterial Agents