The efficacy and safety of azithromycin in chronic respiratory diseases related cough

Background: Azithromycin is potential for preventing exacerbations in chronic respiratory diseases. However, rare attention was paid to the cough symptom of such airway diseases by azithromycin intervention. We summarized the efficacy and safety of azithromycin in chronic respiratory diseases related cough. Methods: We searched 4 electronic databases (PubMed, EMBASE, Cochrane, and Web of Science) to identify randomized controlled trials (RCTs) comparing the change of Leicester Cough Questionnaire (LCQ) score, cough visual analogue scale (VAS) and side effects of azithromycin in patients of chronic respiratory diseases with cough. Results: We identified 5 RCTs (n=879 patients) in pooled analyses. Compared to placebo, azithromycin intervention had no effect in reducing cough [mean difference (MD) 0.73; 95% CI: -0.78 to 2.24; P=0.34] with significant heterogeneity (P=0.03, I-2=71%). However, heterogeneity is caused by one study. After removal of this study, azithromycin administration had shown clinically important improvement in LCQ score (MD 1.30; 95% CI: 1.15-1.46; P<0.00001; I-2=0%). In addition, no significant difference was detected in adverse events and azithromycin administration probably had less central nervous system side effects for chronic respiratory diseases with cough. Conclusions: The addition of oral azithromycin may result in significant benefit for chronic respiratory diseases related cough. Azithromycin was safe for those patients with cough.