Macrolide Use in Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a progressive inflammatory airway disease characterized by non-reversible airflow limitation and chronic respiratory symptoms. Symptoms may periodically worsen during events called acute exacerbations (AECOPD), which are associated with increased airway inflammation. AECOPD are the main drivers of poor disease outcomes, making their prevention and effective treatment key elements of COPD care. Because a significant proportion of events have an infectious trigger, antibiotics remain a mainstay of exacerbation management. Particularly as prophylaxis, macrolides have been associated with greater benefit compared with other antibiotic classes, possibly due to their additive immunomodulatory actions. However, treatment failures are frequent, the effectivity of long-term administration is unclear, and there is concern for the risk of adverse events and bacterial resistance. Presumably, patients with frequent and bacteria-associated exacerbations benefit most. Yet, a better characterization of the responding disease traits is vital, both for prophylaxis and treatment of exacerbations.