Effect of azithromycin in addition to inhaled corticosteroids in severe preschool wheeze: a retrospective cohort study

Introduction: Preschool wheeze is common, and treatment options are limited, consisting mainly of inhaled corticosteroids (ICS). We report here a retrospective study in severe preschool wheezers not controlled by high doses of ICS, who were given azithromycin as long term additional therapy. Methods: We conducted a single center, retrospective study between 2020 and 2025, including children less than 6 years old with severe recurrent wheeze, partially or uncontrolled despite a high dose of ICS and who were given azithromycin three times a week for 6 months as maintenance treatment. Results: Thirty-eight children with a mean age of 2.3 ± 1.2 years were retrospectively included in our center. We found an improvement in the control of wheezing, and a decrease of exacerbations, daily respiratory symptoms and dose of daily ICS after 6 months of azithromycin treatment, without major secondary effect declared. Conclusion: Azithromycin could therefore be considered as an adjunctive treatment in young children with persistent asthma and frequent exacerbations despite high doses of inhaled steroids. This conclusion is from a retrospective study, and it is needed to perform controlled prospective studies to validate these findings.