A common antibiotic added to the usual treatment plan for some patients with chronic obstructive pulmonary disease can reduce acute exacerbations — sudden onsets of worsened cough, wheezing and labored breathing — and improve quality of life, according to findings from the COPD Clinical Research Network reported in the Aug. 25, 2011, issue of the New England Journal of Medicine.

The Lung Health Center at the University of Alabama at Birmingham is one of the 10 sites participating in the COPD Clinical Research Network.

The findings indicate that the antibiotic azithromycin is effective in reducing COPD exacerbations, which are typically caused by bacteria, viruses or a combination of both. Azithromycin is already prescribed for a variety of bacterial infections, including pneumonia and strep throat.

“Exacerbations account for a significant part of the COPD health burden,” said mark T. Dransfield, M.D., director of the UAB Lung Health Center and associate professor in the Division of Pulmonary, Allergy and Critical Care Medicine. “These promising results with azithromycin may help us reduce that burden and improve the lives of patients at risk of these acute attacks.”

Previous studies of cystic fibrosis and other pulmonary diseases suggested that azithromycin might be effective in reducing COPD exacerbations. The study, begun in 2005, enrolled more than 1,000 subjects, 140 of them at UAB and the Birmingham Veterans Affairs Medical Center.

 The 570 study participants, who took 250 mg. of azithromycin daily for a year in addition to their usual care, averaged 1.48 acute COPD exacerbations annually, compared to 1.83 exacerbations for the 572 participants who received their usual care without azithromycin. The participants taking azithromycin also responded more favorably on questionnaires that asked them to assess their breathing ability and overall well-being.

Eighty percent of the study participants already were taking other medications normally used to manage COPD, such as inhaled steroids and long-acting bronchodilators.

Side-effects of this commonly prescribed antibiotic were minimal. Azithromycin increased the presence of antibiotic-resistant microbes in some patients, although no one developed an infection. It also caused slight hearing loss in a small fraction of participants.

Dransfield says azithromycin may be indicated for up to a quarter of the 12 million people in the United States with COPD, particularly those with  moderate to severe disease who require oxygen or who have a history of exacerbations within the past year.

COPD is a progressive disease of the lungs and is now the third leading cause of death in this country, having recently surpassed stroke. There is no cure, though a combination of drugs and lifestyle changes can help manage the symptoms, reduce exacerbations and improve quality of life.

The study was funded by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.  The COPD Clinical Research Network is an NHLBI-funded consortium of research centers located throughout the United States that was established to identify new treatments for COPD.

Collaborators on the study at UAB are William C. Bailey, M.D., and J. Allen D. Cooper, Jr., M.D., professors of pulmonary, allergy and critical care medicine. Cooper also is chief of pulmonary medicine at the Birmingham VA Medical Center.

Latest Lungs News

Study Shows 4 Biomarkers May be Helpful in Diagnosis of Respiratory Conditions

By Salynn BoylesWebMD Health News

Reviewed by Laura J. Martin, MD

March 11, 2011 — Researchers in Australia have identified four molecular characteristics, or biomarkers, of asthma and chronic obstructive pulmonary disease (COPD), which they say could lead to better ways to diagnose the respiratory conditions.

The biomarkers were discovered using a relatively new field of science known as proteomics, which is the study of the proteins that are involved in the make-up of an organism.

Asthma and COPD have many similar symptoms and confirming a diagnosis of either disease remains a challenge, researcher Peter G. Gibson, MD, of the University of Newcastle in New South Wales, Australia tells WebMD.

“In the case of asthma, people are often given inhaled steroids for lifelong use without any objective confirmation of the diagnosis,” he says. “We certainly wouldn’t do that with hypertension or diabetes.”

With COPD, which is commonly smoking related, patients are often diagnosed late in life and late in the course of the disease due to the lack of objective testing, he says.

Developing a Test for Asthma and COPD

In their effort to develop an objective test for asthma and COPD, Gibson and colleagues turned to proteomics.

Proteins are the workhorses of cells, playing crucial roles in just about every aspect of cellular activity.

The hope of proteomics is that by studying how the proteins in human cells interact, researchers will discover better treatments and better ways to diagnose and manage a wide range of diseases.

But the task is daunting: a single gene can code for hundreds of proteins and there are now believed to be between 20,000 to 25,000 protein-coding genes in the human genome. That means each of us has more than 1 million different proteins.

Proteins Involved in Inflammation

In the study, Gibson and colleagues studied the blood samples of 21 people with asthma, five people with COPD, and 17 people with no evidence of respiratory disease.

Recent advances in the field allowed them to separate and compare thousands of proteins in a short period of time.

All four proteins are involved in the regulation of inflammation and are predominantly synthesized in the liver.

The results were confirmed in a separate group of patients and people without asthma or COPD.

University of Newcastle senior research fellow Xiao Van He, who also worked on the study, says the test may also prove useful for following the progress of asthma and COPD treatments in patients with established disease.

“This has the potential to be a revolutionary technique,” she says. “It will allow us to look for these diseases in a completely different way.

SOURCES: Verrills, N.M. American Journal of Respiratory and Critical Care Medicine, March 11, 2011; online edition.Peter G. Gibson, MD, conjoint professor, University of Newcastle, New South Wales, Australia.Xiao Yan He, senior research fellow, University of Newcastle, New South Wales, Australia.News release, American Thoracic Society.genomics.energy.gov: “Human Genome Project Information.”©2011 WebMD, LLC. All Rights Reserved.

COPD (chronic obstructive pulmonary disease) kills more than 120,000 adults each year — one death every four minutes on average, or more than breast cancer and diabetes combined.

In COPD, sometimes referred to as emphysema or chronic bronchitis, the tubes that carry air in and out of the lungs are partially blocked, which makes it hard to breathe.

“Yet people go undiagnosed and untreated because they don’t recognize the symptoms,” says James P. Kiley, director of the National Heart, Lung and Blood Institute, part of the National Institutes of Health.

The institute has launched a public service announcement campaign to highlight common COPD signs and symptoms, including frequent shortness of breath, chronic cough, wheezing and excessive phlegm production. Kiley discusses the disease.

Q. you indicate that this serious health problem is often associated with former smokers.

A. too many people think it’s part of getting older or being out of shape. Smoking accounts for as many as nine out of 10 COPD-related deaths. However, as many as one out of six people who have COPD never smoked.

Q. if not from smoking, what causes COPD?

A. it can be environmental — exposure to chemicals, dusts and pollutants as well as from exposure to secondhand smoke. Doctors just can’t say to stop smoking and the disease threat will never happen or go away.

Lower- and middle-income women seem to be particularly vulnerable, although many have never smoked.

In can be the result of indoor pollution, a not-well-ventilated environment, as well as poorly ventilated homes.

We are not sure why we have a continuing growing number of nonsmoking women getting the disease.

Q. it takes awhile for the disease to appear in former heavy smokers, I understand.

A. it takes quite a long time for most people — even those who were heavy smokers — to develop the disease. But, of course, the boomer population is aging.

We have had a good effect in lowering the smoking rates in this country, but there are people in the pipeline who still will get lung cancer and COPD as a result of smoking years ago.

Q. What can you do to help people find out if they have COPD?

A. well, we need to get people to recognize the symptoms and to talk to their health care providers. There is a simple breathing test called spirometry that is quick and painless and can be taken at a doctor’s office.

There is no cure for COPD, but the earlier a person gets diagnosed and receives treatment, the better their chance to improve quality of life. It’s all a matter of better education.

Q. People are living longer these days. Does that contribute to more cases?

A. well, yes, it could.

There also is a genetic version of the disease that is not lethal but also produces almost the same manifestations of COPD. One in five persons with the disease has a genetic background. Perhaps with further research, we can learn about protective genes.

Q. There are commercials on TV that feature an inhaler.

A. That’s the drug commonly used.

Another treatment that improves lung conditions and even prolongs life is exercise.

There also are resources available to people to quit if they are still smoking.

Q. bottom line?

A. if you do or have smoked, you may have the symptoms or be susceptible to COPD. it is a treatable disease and we have tools available to improve you quality of life. But you must see your health care professional.

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Jane Glenn Haas writes for the Orange County (Calif.) Register. E-mail her at