{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T23:27:33Z","timestamp":1787873253485,"version":"build-2784847793"},"reference-count":36,"publisher":"European Respiratory Society (ERS)","issue":"2","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006636","name":"Forskningsr\u00e5det om H\u00e4lsa, Arbetsliv och V\u00e4lf\u00e4rd","doi-asserted-by":"publisher","award":["2023-02030 and 2020-00922"],"award-info":[{"award-number":["2023-02030 and 2020-00922"]}],"id":[{"id":"10.13039\/501100006636","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Swedish Heart and Lung Foundation","award":["20210440"],"award-info":[{"award-number":["20210440"]}]},{"DOI":"10.13039\/501100024950","name":"Novo Holdings","doi-asserted-by":"publisher","award":["0052256"],"award-info":[{"award-number":["0052256"]}],"id":[{"id":"10.13039\/501100024950","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2026,4,1]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Viral respiratory infections are the leading trigger of asthma exacerbations, and impaired epithelial type I and III interferon (IFN) responses may contribute to more severe exacerbations. Azithromycin reduces exacerbations clinically, but its effects on epithelial antiviral immunity remain unclear. This study investigated whether azithromycin treatment enhances airway epithelial antiviral responses and modulates alarmin concentrations in patients with uncontrolled asthma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In the investigator-initiated, double-blind, placebo-controlled AZIMUNE trial, 40 adults with uncontrolled asthma were randomised (1:1) to azithromycin (500\u2005mg three times per week) or placebo (identical regimen) for 12\u2005weeks. Bronchial epithelial cells were obtained\n                      <jats:italic>via<\/jats:italic>\n                      bronchoscopy at baseline and after week 12, and cultured and infected\n                      <jats:italic>ex vivo<\/jats:italic>\n                      with rhinovirus. Protein levels of IFN-\u03b2, IFN-\u03bb, alarmins (interleukin (IL)-33 and thymic stromal lymphopoietin (TSLP)) and pro-inflammatory cytokines were quantified.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Azithromycin significantly increased rhinovirus-induced concentrations of IFN-\u03b2 (p=0.047) and IFN-\u03bb (p=0.013) in the azithromycin group (n=16) compared with baseline, whereas no change was seen in the placebo group (n=16). Azithromycin treatment also reduced IL-33 concentrations (p=0.001), while TSLP levels were unaffected. Clinical outcomes improved numerically in the azithromycin group, but differences\n                      <jats:italic>versus<\/jats:italic>\n                      placebo were not statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Azithromycin enhances epithelial antiviral immunity and attenuates IL-33 concentrations in response to rhinoviral infection in asthma. The dual immunomodulatory effect of azithromycin supports its role as adjunctive therapy to prevent virus-induced exacerbations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1183\/13993003.02441-2025","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T14:05:19Z","timestamp":1778162719000},"page":"2502441","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Azithromycin enhances epithelial antiviral immunity in uncontrolled asthma: results from the AZIMUNE randomised controlled trial"],"prefix":"10.1183","volume":"68","author":[{"given":"Muzhda","family":"Ghanizada","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Malm 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