Chronic obstructive pulmonary disease (COPD) is a common progressive respiratory condition with a heavy symptom burden and was the third leading cause of death worldwide in 2019.1 One tool in the GP’s arsenal is prophylactic antibiotics, with macrolides being the most effective. These are thought to both reduce the frequency of infective exacerbations via the antimicrobial effect of neutrophil activation and combat excessive airway inflammation by induction of T helper type 1 lymphocytes, which act to combat inflammation and cause thinning of the bacterial biofilm.2 The benefits of macrolides have been proven, but which patients are most likely to benefit from them, and which healthcare providers are best placed to identify them?
PATIENTS WITH MILD OR SEVERE DISEASE
The first question to explore is whether prophylactic macrolide use could be of most benefit to those with mild COPD or those with moderate-to-severe disease. A meta-analysis examining the effect of macrolide prophylaxis in the moderate-to-severe disease cohort has shown a significant reduction in the number of exacerbations with macrolide use versus placebo across all 14 studies examined.3 Furthermore, six of seven studies within this analysis showed the time to first exacerbation was significantly lengthened in the treatment groups.3 However, participants who had already been experiencing exacerbations requiring hospitalisation showed no significant reduction in …
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