Trial reportThorax2017
Randomised, double-blind, placebo-controlled trial with azithromycin selects for anti-inflammatory microbial metabolites in the emphysematous lung.
Trial report in Thorax, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02557958 (Chronic Obstructive Pulmonary Disease Transcription Factor and Cytokine Study), which is not on this map. Cited by 106 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Chronic Obstructive Pulmonary Disease Transcription Factor and Cytokine Study
Who cites it
106 citing papers in PubMed, 3 syntheses or guidelines pooled it, 174 citations in OpenAlex.
- Multi-omic meta-analysis identifies functional signatures of airway microbiome in chronic obstructive pulmonary disease.The ISME journal · 2020Pooled it
- Passive immune therapy and other immunomodulatory agents for the treatment of severe influenza: Systematic review and meta-analysis.Influenza and other respiratory viruses · 2020Pooled it
- Prophylactic antibiotic therapy for chronic obstructive pulmonary disease (COPD).The Cochrane database of systematic reviews · 2018Pooled it
- Azithromycin for Bacterial Watery Diarrhea: A Reanalysis of the AntiBiotics for Children With Severe Diarrhea (ABCD) Trial Incorporating Molecular Diagnostics.The Journal of infectious diseases · 2024Trial
- Azithromycin Exposure Induces Transient Microbial Composition Shifts and Decreases the Airway Microbiota Resilience from Outdoor PMMicrobiology spectrum · 2023Trial
- Assessment of Long-Term Macrolide Exposure on the Oropharyngeal Microbiome and Macrolide Resistance in Healthy Adults and Consequences for Onward Transmission of Resistance.Antimicrobial agents and chemotherapy · 2022Trial
- Trial
- Targeted Retreatment of Incompletely Recovered Chronic Obstructive Pulmonary Disease Exacerbations with Ciprofloxacin. A Double-Blind, Randomized, Placebo-controlled, Multicenter, Phase III Clinical Trial.American journal of respiratory and critical care medicine · 2020Trial
- The role of the respiratory microbiome in acute and chronic respiratory diseases.Nature reviews. Microbiology · 2026Review
- The Role of the Respiratory Microbiome in Pneumonia.Clinics in chest medicine · 2026Review
- May nutrients and dietary supplements influence the gut-lung microbiota axis in chronic obstructive pulmonary disease and exacerbations?Archives of medical science : AMS · 2026Article
- Mechanisms, Efficacy, Safety, and Pharmacoeconomics of Low-Dose, Long-Term Macrolide Antibiotics in the Treatment of Chronic Obstructive Pulmonary Disease: A Review.International journal of chronic obstructive pulmonary disease · 2026Review
- Tibetan Medicine Liuwei Dingxiang Pills Decoction InhibitsInfection and drug resistance · 2026Article
- Metagenomic next-generation sequencing unraveled the characteristic of lung microbiota in patients with checkpoint inhibitor pneumonitis: results from a prospective cohort study.Journal for immunotherapy of cancer · 2025Observational
- The use of macrolides in the treatment of community-acquired pneumonia: risks and benefits.Breathe (Sheffield, England) · 2025Article
- Towards airway microbiome engineering for improving respiratory health.Advanced drug delivery reviews · 2025Review
- Article
- Immunity AgainstVaccines · 2025Article
- Inhaled PAMAM-based nano-formulation prolonged lung retention for alleviating pulmonary inflammation of COPD.Materials today. Bio · 2025Article
- The lung microbiome in interstitial lung disease.Breathe (Sheffield, England) · 2025Review
46 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
10 authors at 3 institutions in 1 country.
Funding
Abstract
introductionAzithromycin (AZM) reduces pulmonary inflammation and exacerbations in patients with COPD having emphysema. The antimicrobial effects of AZM on the lower airway microbiome are not known and may contribute to its beneficial effects. Here we tested whether AZM treatment affects the lung microbiome and bacterial metabolites that might contribute to changes in levels of inflammatory cytokines in the airways.
methods20 smokers (current or ex-smokers) with emphysema were randomised to receive AZM 250 mg or placebo daily for 8 weeks. Bronchoalveolar lavage (BAL) was performed at baseline and after treatment. Measurements performed in acellular BAL fluid included 16S rRNA gene sequences and quantity; 39 cytokines, chemokines and growth factors and 119 identified metabolites. The response to lipopolysaccharide (LPS) by alveolar macrophages after ex-vivo treatment with AZM or bacterial metabolites was assessed.
resultsCompared with placebo, AZM did not alter bacterial burden but reduced α-diversity, decreasing 11 low abundance taxa, none of which are classical pulmonary pathogens. Compared with placebo, AZM treatment led to reduced in-vivo levels of chemokine (C-X-C) ligand 1 (CXCL1), tumour necrosis factor (TNF)-α, interleukin (IL)-13 and IL-12p40 in BAL, but increased bacterial metabolites including glycolic acid, indol-3-acetate and linoleic acid. Glycolic acid and indol-3-acetate, but not AZM, blunted ex-vivo LPS-induced alveolar macrophage generation of CXCL1, TNF-α, IL-13 and IL-12p40.
conclusionAZM treatment altered both lung microbiota and metabolome, affecting anti-inflammatory bacterial metabolites that may contribute to its therapeutic effects. TRIAL REGISTRATION NUMBER: NCT02557958.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.