Anti-viral Effects of Azithromycin in Patients With Asthma and COPD

Inclusion Criteria: * Asthma patients (n=40) 1. Diagnosis of asthma according to GINA, with confirmed variable airflow obstruction at screening visit or previously. 2. Age ≥ 18 through 75 years. 3. A postbronchodilator FEV1 ≥ 50% predicted 4. Maintenance treatment with ICS and ≥ 1 second controller (LABA, LAMA, LTRA or Xanthines) for at least three months prior to Visit 1. 5. Non-smokers (\<10 packyears, quit \>6 months). 6. ≥ 1 Systemic steroid treated exacerbation in the past one year despite maintenance treatment with inhaled corticosteroids. 7. Eosinophilic (n=20, blood eosinophils ≥ 0.200x109/L) and non-eosinophilic (n=20, blood eosinophils \<0.200x109/L) phenotypes. * COPD patients (n=40) 1. Diagnosis of COPD according to GOLD 2. Age ≥ 45 through 75 years. 3. ≥ 10 packyears smoking history (current or ex-smokers). 4. A postbronchodilator FEV1 ≥ 30% predicted. 5. Maintenance treatment with long-acting bronchodilators (LABA and/or LAMA) ≥ ICS. 6. ≥ 1 Systemic steroid and/or antibiotic treated exacerbation in the past one year. 7. Eosinophilic (n=20, blood eosinophils ≥0.200x109/L) and non-eosinophilic (n=20, blood eosinophils \<0.200x109/L) phenotypes. * Healthy controls (n=20) 1. Asymptomatic 2. Non-smoking (\<10 packyears, quit \>6 months) 3. Normal spirometry (FEV1, FVC, FEV1/FVC ratio: all \>LLN) 4. FeNO \< 25 ppb 5. Non-atopic based on skin-prick test 6. Negative mannitol provocation test 7. Younger (n=10, 18-45 years) and older (n=10, \>45-75 years) subjects. Exclusion Criteria: * Any of the following would exclude the subject from participation in the study: 1. Previous medical history or evidence of an uncontrolled intercurrent illness that in the opinion of the investigator may compromise the safety of the subject in the study or interfere with evaluation of the investigational product or reduce the subject's ability to participate in the study. Subjects with well-controlled comorbid disease (e.g., hypertension, hyperlipidemia, gastroesophageal reflux disease) on a stable treatment regimen for 15 days prior to Visit 1 are eligible. 2. Any concomitant respiratory disease that in the opinion of the investigator and/or medical monitor will interfere with the evaluation of the investigational product or interpretation of subject safety or study results (e.g., cystic fibrosis, pulmonary fibrosis, moderate-severe bronchiectasis, allergic bronchopulmonary aspergillosis, Churg-Strauss syndrome, active tuberculosis). In addition for the different groups the following: 1. Patient with asthma: concomitant COPD. 2. Patients with COPD: concomitant asthma (former and current) 3. Healthy subjects: COPD and asthma. 3. Any clinically relevant abnormal findings in hematology or clinical chemistry (laboratory results from Visit 1), physical examination, vital signs during the screening, which in the opinion of the investigator, may put the subject at risk because of his/her participation in the study, or may influence the results of the study, or the subject's ability to participate in the study. 4. Evidence of active liver disease, including jaundice or aspartate transaminase, alanine transaminase, or alkaline phosphatase \>1.5 times the upper limit of normal (laboratory results from Visit 1). 5. GFR \<30 ml/min. 6. Acute upper or lower respiratory infections requiring antibiotics or antiviral medications within 2 weeks prior to Visit 1, during the run-in period, or at Visit 2 (randomization). 7. A positive human immunodeficiency virus (HIV) test at screening or subject taking antiretroviral medications, as determined by medical history and/or subject's verbal report. 8. History of sensitivity to any component of the investigational product formulation or a history of drug or other allergy that, in the opinion of the investigator or medical monitor contraindicates their participation. 9. History of any known primary immunodeficiency disorder excluding asymptomatic selective immunoglobulin A or IgG subclass deficiency. 10. Receipt of any of the following within 30 days prior to Visit 1: 1. Immunoglobulin or blood products, or 2. Receipt of any investigational non-biologic agent within 30 days or 5 half-lives prior Visit 1, whichever is longer. 11. Pregnant, breastfeeding or lactating females 12. History of chronic alcohol or drug abuse within 12 months prior to Visit 1. 13. Planned surgical procedures requiring general anesthesia or in-patient status for \> 1 day during the conduct of the study. 14. Unwillingness or inability to follow the procedures outlined in the protocol. 15. Concurrent enrollment in another clinical study involving an investigational treatment. 16. Receipt of any live or attenuated vaccines within 15 days prior to Visit 1. 17. Long QTc interval on ECG (QTc \>480msec). 18. History of the following cardiac comorbidities: 1. Life-threatening arrhythmias 2. Myocardial infarction (NSTEMI or STEMI) less than 6 months before start of the study 3. Unstable angina 4. History of severe heart failure 19. Documented severe hypokalemia (K \<3.0 mmol/L) or hypomagnesemia (Mg \<0.5 mmol/L). 20. Life expectancy \<6 months. 21. Hearing impairment. 22. Oxygen saturation \<92% at room air, patients on LTOT, history of chronic respiratory failure (hypercapnia).