How exactly does Azithromycin help symptoms?

I am only on 250 mg Azithromycin every other day for the past 11 months. During that time I have had zero exacerbations and the way I understand it, the Azithro acts as an anti-inflamatory. I would not say I have decreased mucus. I would say that with the 3% sodium chl. I have easy mucus, easy to expel. I think somehow the azithro helps clear out the lungs of the stuff. I don't think it makes mucus but does somehow help along with the 3% to get it out of your lungs which is the whole point of not getting an infection. I think it does other stuff too like making a bad environment for bugs but not sure how that works. I have pseudomonas and that is why I take it. I will probably be going off it for a while soon as 1 yr is what has been studied as far as I know. I still have coughing...but I am walking up a steep hill now so...the cough is now just an annoyance. In any case I feel better in a way that is not connected to mucus quantity or frequency of cough....if that helps?

Thanks for sharing your experience with it, every bit of info helps!

https://journals.sagepub.com/doi/10.1177/0300060520932104
This article suggests that Azithromycin will effect (lessen) mucus production
" Some studies showed that macrolides can directly inhibit secretion of MUC5AC by airway epithelial cells, potentially reflecting their potential as new anti-inflammatory drugs for the treatment of chronic sinusitis.13 In the clinic, AZM has a significant inhibitory effect on airway mucus secretion."

note maybe I do have a bit less than before.

Wow. I would sure be happy if this winds up helping. I'm drowning in goo today, and so very tired of expelling it.

What infection were you diagnosed with? I took Azithromycin for for 40 months over the last 5 years and initially azithromycin by IV 5 years ago and recently by IV for my first and severe case of covid?

This is a snippet I posted in the constant cough thread. Here it is again. From medical article in 2022: Bronchiectasis — A Clinical Review (New England Journal of Medicine) by Anne E. O’Donnell, M.D.

"For patients with substantial daily symptoms and frequent exacerbations (three or more per year), additional therapies may be required to improve quality of life and prevent further lung damage. In a meta-analysis of three randomized trials, investigators found that the use of macrolide antibiotics reduced the frequency of exacerbations and increased the time until the next exacerbation. Improvements in quality of life were also documented in those trials. The mechanism of action is unclear, although macrolides may inhibit quorum sensing by P. aeruginosa. The usual dosing regimen is azithromycin at a dose of 500 mg three times per week or 250 mg daily. Although the studies were conducted for only 1 year, it seems that macrolides are generally safe and have an acceptable side-effect profile over longer durations. However, caution must be observed when prescribing macrolides, given the risk of resistance and gastrointestinal, cardiac, and auditory side effects. Macrolide monotherapy should not be used when nontuberculous mycobacterial infection is present or has not yet been ruled out."

Doc says that for me its about immune environment in lungs, not infection, as I have none! I resisted at first because of this, but have been convinced to try after reading further, also some posts here by others .

For me, I decided not to take azithromycin even though I was in the camp of frequent exacerbations. I found that lung clearance 2x day (levalbuterol or albuterol inhaler & 7% saline) was enough to keep the bugs at bay and diminish the frequent infections. My reasoning was to save antibiotics for when I needed them and not to take prophylactically.

Having bronchiectasis makes us prone to various pathogens including MAC/NTM. Azithromycin is one of the mainstays of treatment for MAC. My chances for contracting MAC are not zero, which means I might need azithromycin someday. We're all different and need to make these decisions with our doctors. Thought I'd share an opposing view in case that helps anyone.

One of the ‘side effects’ of Azithromycin is hearing loss. I was on it for almost 4 years and only then looked up side effects of the big three. I have sustained a substantial hearing loss which affects me (asking my husband “what?”) and him getting frustrated because I continually ask him “What?”. I only wish I had been advised to get a baseline hearing test before I started taking it.

You might want to get another opinion. I've never heard of AZ prescribed as mono-therapy or without an infection. You don't want to build a resistance to AZ because you might really need it someday