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[Correspondence] How does azithromycin improve asthma exacerbations?

We read with interest the Article by Peter G Gibson and colleagues (July 4, 2017, p 659),1 which clearly showed the beneficial effects of macrolide therapy on the incidence of asthma exacerbations. Increasingly, asthma is recognised as a heterogeneous disease with multiple phenotypes and endotypes. By contrast with the effects of anti-inflammatory treatment with inhaled corticosteroids, leukotriene receptor antagonists, and biological therapies—for which therapeutic efficacy depends on the inflammatory profile—Gibson and colleagues showed no differential benefit in terms of eosinophilic inflammation over non-eosinophilic inflammation.