Azithromycin During Wheezing Illnesses Among Preschool Children - Does the Airway Microbiota Provide Insights into Mechanism?

Young children often experience recurrent episodes of respiratory tract illnesses manifested by wheezing, cough, and breathlessness. A substantial fraction of these episodes can be quite impactful, leading to high rates of health care use along with frequent prescription of bronchodilators and systemic corticosteroids (which are not without consequences). Despite the commonplace use of these approaches, studies suggest that systemic corticosteroids may not be as effective in improving clinical symptoms as generally thought, prompting research examining alternative treatment strategies. Potential explanations have included antiinflammatory actions (6, 7), antiviral effects (8), and/or classical antimicrobial effects. Although viruses have long been considered the dominant infectious driver of these episodes, recent culture-based and non-culture-based detection of bacteria in the upper airways of affected children have drawn significant attention to the role of these bacteria in illness pathogenesis.