Adults with persistent symptomatic asthma experience fewer asthma exacerbations and improved quality of life when treated with oral azithromycin for 48 weeks. Azithromycin might be a useful add-on therapy in persistent asthma. Between June 12, 2009, and Jan 31, 2015, 420 patients were randomly assigned (213 in the azithromycin group and 207 in the placebo group). Azithromycin reduced asthma exacerbations (1·07 per patient-year [95% CI 0·85–1·29]) compared with placebo (1·86 per patient-year [1·54–2·18]; incidence rate ratio [IRR] 0·59 [95% CI 0·47–0·74]; p<0·0001).

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