Virginia Research Day 2025

Medical Student Research Clinical

24 The Role of Azithromycin in Acute Exacerbations of COPD Caused by Viral Pneumonia

Ramzi Badra; Rozlan Basha; Dylan Carlson; Zackary Schoonover; Leona Jafari; Eli Louwagie, MD, PhD; J. Mahaney, PhD Corresponding author: rbadra@vcom.edu

Edward Via College of Osteopathic Medicine – Virginia Campus LewisGale Hospital Montgomery, Internal Medicine

Chronic Obstructive Pulmonary Disease (COPD) exacerbations triggered by viral pneumonia frequently require hospitalization, contributing heavily to patient morbidity and healthcare costs. Given the life threatening potential of these exacerbations, empiric antibiotics are often started prior to identification of the offending organism. Azithromycin (AZM), an antibiotic with anti-inflammatory properties, improves patient outcomes in bacterial pneumonia and reduces the frequency of COPD exacerbations when used prophylactically. However, the potential benefits of AZM during COPD exacerbations due to viral pneumonia have not been elucidated. We hypothesized that treatment of COPD exacerbations due to viral pneumonia with azithromycin would be positively associated with better clinical status

(per improved arterial blood gas (ABG) values) and subjective outcomes. This retrospective cohort study compared two patient groups: one experimental group receiving AZM on or within five days prior to hospitalization for a viral COPD exacerbation and a control group without AZM use. Key endpoints included the patient's ABG values and qualitative measures based on the St. George's Respiratory Questionnaire (SRQ), a validated measure of subjective respiratory status. Data were analyzed using a combination of descriptive and inferential statistics. Unpaired T-tests revealed no statistically significant differences between groups in terms of arterial pH, arterial CO2, or arterial O2, giving p-values of 0.835, 0.356, and 0.625, respectively. Patients treated with

AZM for their acute exacerbation showed statistically better quality of life measures based on the SRQ, which included wheezing, dyspnea, sputum, and cough given a p-value of 0.044 by chi-square analysis. While we found no statistically significant effect on clinical outcomes by way of ABG measures, AZM may still improve quality of life in COPD exacerbations secondary to viral pneumonia. Future studies will investigate the potential roles of inflammatory/serum markers, such as leukocyte involvement, d-dimers, red cell distribution width, and brain natriuretic peptide, in comprehensive risk stratification.

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