Effects of Azithromycin on Airway Oxidative Stress Markers in Patients With Bronchiectasis

• Number of Exacerbations [ Time Frame: Before and after three months of treatment ] [ Designated as safety issue: No ]
  exacerbations was defined by hospital admissions or antibiotics prescription
• changes in lung function [ Time Frame: Before and after three months of treatment ] [ Designated as safety issue: No ]
  Changes in FEV1, FVC.
• colour and volume sputum, [ Time Frame: Before and after three months of treatment ] [ Designated as safety issue: No ]
  In order to analyze sputum characteristics, three sterile containers were given to collect all sputum produced during three consecutive days. The average of the three days was calculated and expressed in mL/day. Sputum colour was scored using a scale developed and validated in our laboratory, which ranged from zero to fifteen: transparent (0), white (1), progressive intensities of yellow (2-7), green (8-10) and brown (10-15). Colour scores were decided after agreement between two investigators
• Impact on functional capacity and health related quality of life [ Time Frame: Before and after three months of treatment ] [ Designated as safety issue: No ]
  The impact on functional capacity and patient´s daily life was evaluated with the Medical Research Council Dyspnea scale (MRC) and the Spanish version of the Saint George's respiratory questionnaire of quality of life (SGRQ)
• Changes in HRCT Lung scores [ Time Frame: Before and after three months of treatment ] [ Designated as safety issue: No ]
  Standard lung HRCT scan was performed to quantify the extension of bronchiectasis

The mechanism by which macrolide antibiotics have immune modifying effects independent from its antibacterial activity has not been well established. In the present work, the investigators will analyze the effect of long-term treatment with azithromycin (250 mg three times per week during three months) on airway oxidative stress markers in exhaled breath condensate of adult patients with stable non-CF bronchiectasis.

The mechanism by which macrolide antibiotics have immune modifying effects independent from its antibacterial activity has not been well established. In the present work, we will analyze the effect of long-term treatment with azithromycin (AZ) on airway oxidative stress markers in exhaled breath condensate of adult patients with stable non-CF bronchiectasis. Patients will be randomized in an open label model to receive AZ 250 mg three times per week during three months or nothing.Dyspnea (Borg scale), exacerbations (Nº) in the last three months, sputum volume (cc), sputum colour (15-point scale), and health related quality of life (Questionnaire St.George) will be measured in both groups before and after treatment. Lung function, sputum culture, CT scan (Bhalla score) and inflammatory markers in blood (ESR, PCR),exhaled air (Nitric Oxide,) and exhaled condensed air (pH, nitrites, isoprostane) will be assessed before and after treatment. Relationships between clinical and inflammatory markers will be studied

• No Intervention: Control
  without azithromycin
  Intervention: Drug: Azithromycin
• Active Comparator: azithromycin
  treatment with azithromycin during three months
  Intervention: Drug: Azithromycin

Inclusion Criteria:

• Previous diagnosis of bronchiectasis based on lung HRCT and clinical symptoms
• Clinically stable in previous four weeks without exacerbations
• Informed consent

Exclusion Criteria:

• Bronchiectasis secondary to Cystic fibrosis, pulmonary surgical processes, immune deficiency, emphysema, allergic bronchopulmonary aspergillosis or diffuse interstitial pulmonary diseases
• Intolerance to macrolides or severe liver disease.