Asthma is the most common chronic respiratory disease in children.

It is both underdiagnosed and overdiagnosed in children

The standard treatment for childhood asthma is inhalational corticosteroid(ICS) in different doses according to the severity of asthma.

If the asthma is not controlled, on highest permissible doses of inhalational steroid,Long acting beta agonist(LABA) is added to control it, provided the technique of inhalation is correct,comorbidities have been addressed properly and allegen avoidence has been taken care of and adherence to treatment is good.

If it is not controlled on ICS+LABA,other add on options are LTRA(Monteleukast) and Tiotropium

If still the asthma is not controlled ,biologicals in the form of Omalizumab(IgE antagonist) and Meplozumab(IL5 antagonist) are given to control the asthma

Biologicals are costly with the disadvantages of adverse events and it is not widely available.

Asthma control is usually assessed by Asthma control test(ACT) ,Childhood asthma control test(CACT) and more easily by GINA guideline for control of asthma

Higher the ACT,CACT scores ,better is the control of asthma.

Researchers from the division of Pulmonology,department of Pediatrics,All India Institute of Medical Sciences,conducted an open label randomized control trial for a drug Azithromycin.Azithromycin is recommended drug by Global Initiative of Asthma(GINA) and British Thoracic Society(BTS) guideline for control of Asthma in adults.It improves spirometer parameter and reduces number of exacerbation of asthma in adults.There is no sufficient data for its use in children.

This the reason, researchers from Pediatric Pulmonology, division of the department of Pediatrcs AIIMS New Delhi, studied on 120 children between the age group of 5-15 years,mostly male(74% ) with poorly controlled asthma according to ACT and CACT.They divided these children into two groups.One group (n60) received Azithromycin in the dose of 10 mg/kg thrice weekly for 12 weeks along with standard treatment.The other group(n60) received only standard treatment.

The primary outcome was level of control of Asthma, according to ACT and CACT.Secondary outcomes were spirometry parameter,number of exacerbations,,Fractional excretion of NO(FeNO),throat swab culture positivity and adverse events

At the end of study period,the group who received Azithromycin along with standard care were having high ACT and CACT score (21.71 vs. 18.33; P < .001))indicating better asthma control.They also required less number of emergency visits due to asthma exacerbation and less use of oral or injectable steroids(0 vs. 1; P < .001).) ,higher number of good control of asthma by GINA guideline(41 vs. 10; P < .001).)

Spirometry parameters,throat swab culture ,FeNO reports and adverse events were not much different between two groups.

The benefits of Azithromycin was not different whether the child was suffering from eosinophilic or non eosinophilic asthma.

The study was published in CHEST.

CONCLUSION and BOTTOM LINE: Azithromycin in the dose of 10mg/kg,thrice weekly for 3 months may be added in treatment for children who could not achieve good control of asthma with standard therapy

REFERENCES:: Ghimire JJ, et al. Chest. 2022;doi:10.1016/j.chest.2022.02.025.