Background: Acute Exacerbations of Chronic Obstructive Pulmonary Disease [E-COPD] can significantly influence the natural course of the disease, leading to a decrease in the quality of life, frequent hospitalizations & higher mortality rates. Infective & inflammatory insults to airways are associated with E-COPD, thus prophylactic macrolides may be a potential approach to prevent E-COPD owing to their anti-inflammatory and immunomodulatory properties.

Aim & Objective: To study the effect of Azithromycin maintenance therapy in prevention of COPD exacerbations.

Methods: 90 patients with a history of at least one episode of E-COPD in past year were enrolled. 45 patients were given oral azithromycin 500 mg thrice weekly for six months & the other 45 patients were enrolled as controls. Patients were followed up for six months to assess the frequency of further exacerbations. 

Results: A mean number of 0.64±0.61 AECOPD episodes were reported in the study group which was significantly lower than 1.13 ± 0.66 episodes reported in the control group during six months follow-up. Univariate analysis identified GOLD Class E & Blood Eosinophil count <2% as factors significantly associated with increased AECOPD episodes in the study group. Age (>65years), male sex, reformed smokers, Stage III COPD, GOLD Class B & E and blood eosinophil count  ?2% were identified as predictors of response to Azithromycin.

Conclusion: Azithromycin maintenance therapy as an adjunct to standard treatment appears to be effective in reducing E-COPD episodes. Blood eosinophil count ?2%, age >65 years, male sex, reformed smokers, Stage III COPD, GOLD Class B & E predict a response to Azithromycin therapy.