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Cochrane Database of Systematic Reviews

Macrolides for chronic asthma

Overview of attention for article published in Cochrane database of systematic reviews, September 2015
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About this Attention Score

  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (90th percentile)
  • Above-average Attention Score compared to outputs of the same age and source (61st percentile)

Mentioned by

2 policy sources
21 tweeters
3 Facebook pages


102 Dimensions

Readers on

281 Mendeley
Macrolides for chronic asthma
Published in
Cochrane database of systematic reviews, September 2015
DOI 10.1002/14651858.cd002997.pub4
Pubmed ID

Kayleigh M Kew, Krishna Undela, Ioanna Kotortsi, Giovanni Ferrara


Asthma is a chronic disease in which inflammation of the airways causes symptomatic coughing, wheezing, and difficult breathing. The inflammation may have different underlying causes, including a reaction to infection in the lungs. Macrolides are antibiotics with antimicrobial and antiinflammatory activities that have been used long-term to control asthma symptoms. To assess the effects of macrolides for managing chronic asthma. We searched the Cochrane Airways Group Specialised Register up to April 2015. We also manually searched bibliographies of previously published reviews and conference proceedings and contacted study authors. We included records published in any language in the search. Randomised controlled clinical trials involving both children and adults with chronic asthma treated with macrolides versus placebo for more than four weeks . Two reviewers independently examined all records identified in the searches then reviewed the full text of all potentially relevant articles before extracting data in duplicate from all included studies. Twenty-three studies met the inclusion criteria, randomising a total of 1513 participants to receive macrolide or placebo. The quality of evidence was generally very low due to incomplete reporting of study methodology and clinical data, suspected publication bias, indirectness of study populations, risk of bias and imprecision (because of small numbers of patients and events). Most of the included studies reported data from patients with persistent or severe asthma, but inclusion criteria, interventions and outcomes were highly variable.Macrolides were not found to be better than placebo for the majority of clinical outcomes including exacerbations requiring hospital admission (odds ratio (OR) 0.98, 95% confidence interval (CI) 0.13 to 7.23; participants = 143; studies = 2; I(2) = 0%) or at least treatment with oral steroids (OR 0.82, 95% CI 0.43 to 1.57; participants = 290; studies = 5; I(2) = 0%). The evidence on symptom scales (standard mean difference (SMD) -0.04, 95% CI -0.36 to 0.28), asthma control (SMD -0.05, 95% CI -0.26 to 0.15), quality of life (mean difference (MD) 0.06, 95% CI -0.12 to 0.24) and rescue medication use (MD -0.26, 95% CI -0.65 to 0.12) was all of very low quality and did not show a benefit of macrolide treatment. There was some evidence that macrolides led to some improvement in lung function (forced expiratory volume in one second (FEV1): MD 0.08, 95% CI 0.02 to 0.14), although not on all the measures we assessed. Measures of bronchial hyperresponsiveness were too varied to pool, but most studies showed no clear benefit of macrolide over placebo. Two studies recruiting people taking regular oral corticosteroids suggested macrolides may have a steroid-sparing effect in this population. Macrolides were well tolerated with respect to severe adverse events, although less than half of the studies reported the outcome (OR 0.80, 95% CI 0.24 to 2.68; participants = 434; studies = 7; I(2) = 0%). Reporting of specific side effects was too patchy across studies to analyse meaningfully. As already reported in the previous versions of the systematic review, biomarkers of asthma activity, such as sputum and serum level of eosinophil cationic protein (ECP) or sputum and serum eosinophils, were lower in patients treated with macrolides, but this was not associated with clinical benefits.Two within-study subgroup analyses showed a possible benefit of macrolides for non-eosinophilic asthma, but it was not possible to investigate this further using the data available for this review. Existing evidence does not show macrolides to be better than placebo for the majority of clinical outcomes. However, they may have a benefit on some measures of lung function, and we cannot rule out the possibility of other benefits or harms because the evidence is of very low quality due to heterogeneity among patients and interventions, imprecision and reporting biases.The review highlights the need for researchers to report clinically relevant outcomes accurately and completely using guideline definitions of exacerbations and validated scales. The possible benefit of macrolides in patients with non-eosinophilic asthma based on subgroup analyses in two of the included studies may require further investigation.

Twitter Demographics

The data shown below were collected from the profiles of 21 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 281 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Denmark 1 <1%
Unknown 280 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 37 13%
Student > Bachelor 33 12%
Researcher 29 10%
Student > Ph. D. Student 27 10%
Student > Postgraduate 15 5%
Other 55 20%
Unknown 85 30%
Readers by discipline Count As %
Medicine and Dentistry 100 36%
Nursing and Health Professions 30 11%
Psychology 12 4%
Pharmacology, Toxicology and Pharmaceutical Science 9 3%
Biochemistry, Genetics and Molecular Biology 7 2%
Other 29 10%
Unknown 94 33%

Attention Score in Context

This research output has an Altmetric Attention Score of 18. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 25 February 2019.
All research outputs
of 22,953,506 outputs
Outputs from Cochrane database of systematic reviews
of 12,333 outputs
Outputs of similar age
of 269,242 outputs
Outputs of similar age from Cochrane database of systematic reviews
of 275 outputs
Altmetric has tracked 22,953,506 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 92nd percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 12,333 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 30.6. This one has gotten more attention than average, scoring higher than 67% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 269,242 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 90% of its contemporaries.
We're also able to compare this research output to 275 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 61% of its contemporaries.