Editing Azithromycin (section)

===Airway diseases===
Azithromycin has beneficial effects in the treatment of asthma. It possesses antibacterial, antiviral, and anti-inflammatory properties which contribute to its effectiveness. Asthma exacerbations can be caused by chronic neutrophilic inflammation, and azithromycin is known to reduce this type of inflammation due to its immunomodulatory properties. The recommended dosage for controlling asthma exacerbations with azithromycin is either 500&nbsp;mg or 250&nbsp;mg taken orally as tablets three times a week. In adults with severe asthma, low-dose azithromycin may be prescribed as an add-on treatment when standard therapies such as [[inhaled corticosteroid]]s or long-acting beta2-agonists are not sufficient. Long-term use of azithromycin in patients with persistent symptomatic asthma aims to decrease the frequency of asthma exacerbations and improve their quality of life. While both its anti-inflammatory and antibacterial effects play crucial roles in treating asthma, studies suggest that responsiveness to azithromycin therapy depends on individual variations in lung bacterial burden and microbial composition, collectively referred to as the [[lung microbiome]]. The richness (diversity) of the lung microbiome has been identified as a key factor in determining the effectiveness of azithromycin treatment. Azithromycin has significant interactions with the patient's microbiome. Long-term use of azithromycin reduces the presence of ''H. influenzae'' bacteria in the airways but also increases resistance against macrolide antibiotics. The specific pharmacological mechanisms through which azithromycin interacts with the patient's microbiome remain unknown {{as of|2024|lc=y|post=;}} research continues to explore how changes in microbial composition influence drug efficacy and patient outcomes.<ref name="pmid37650889">{{cite journal |vauthors=Chan M, Ghadieh C, Irfan I, Khair E, Padilla N, Rebeiro S, Sidgreaves A, Patravale V, Disouza J, Catanzariti R, Pont L, Williams K, De Rubis G, Mehndiratta S, Dhanasekaran M, Dua K |title=Exploring the influence of the microbiome on the pharmacology of anti-asthmatic drugs |journal=Naunyn-Schmiedeberg's Arch Pharmacol |volume=397 |issue=2 |pages=751–762 |date=February 2024 |pmid=37650889 |pmc=10791706 |doi=10.1007/s00210-023-02681-5 }}</ref>

Azithromycin appears to be effective in the treatment of [[chronic obstructive pulmonary disease]] through its suppression of inflammatory processes.<ref name="simoens">{{cite journal | vauthors = Simoens S, Laekeman G, Decramer M | title = Preventing COPD exacerbations with macrolides: a review and budget impact analysis | journal = Respiratory Medicine | volume = 107 | issue = 5 | pages = 637–48 | date = May 2013 | pmid = 23352223 | doi = 10.1016/j.rmed.2012.12.019 | doi-access = free | title-link = doi }}</ref> Azithromycin is potentially useful in [[sinusitis]] via this mechanism.<ref>{{cite journal | vauthors = Gotfried MH | title = Macrolides for the treatment of chronic sinusitis, asthma, and COPD | journal = Chest | volume = 125 | issue = 2 Suppl | pages = 52S-60S; quiz 60S-61S | date = February 2004 | pmid = 14872001 | doi = 10.1378/chest.125.2_suppl.52S | url = https://journal.chestnet.org/article/S0012-3692(15)32220-0/fulltext | access-date = 22 March 2020 | archive-date = 27 August 2021 | archive-url = https://web.archive.org/web/20210827234741/https://journal.chestnet.org/article/S0012-3692%2815%2932220-0/fulltext | url-status = live | url-access = subscription }}</ref> Azithromycin is believed to produce its effects through suppressing certain immune responses that may contribute to inflammation of the airways.<ref>{{cite journal | vauthors = Zarogoulidis P, Papanas N, Kioumis I, Chatzaki E, Maltezos E, Zarogoulidis K | title = Macrolides: from in vitro anti-inflammatory and immunomodulatory properties to clinical practice in respiratory diseases | journal = European Journal of Clinical Pharmacology | volume = 68 | issue = 5 | pages = 479–503 | date = May 2012 | pmid = 22105373 | doi = 10.1007/s00228-011-1161-x | s2cid = 1904304 | doi-access = free | title-link = doi }}</ref><ref>{{cite journal | vauthors = Steel HC, Theron AJ, Cockeran R, Anderson R, Feldman C | title = Pathogen- and host-directed anti-inflammatory activities of macrolide antibiotics | journal = Mediators of Inflammation | volume = 2012 | pages = 584262 | date = 2012 | pmid = 22778497 | pmc = 3388425 | doi = 10.1155/2012/584262 | doi-access = free | title-link = doi }}</ref>