Macrolide therapy for recurrent COPD

Michael, a 79-year-old retired office worker, has been referred by his GP for specialist assessment and management. He presents with a 12-month history of recurrent, culture-positive, infective exacerbations of COPD.

Michael stopped smoking 10 years ago after a 35 pack-year history.

His most recent respiratory function tests showed moderately severe airflow obstruction with FEV1 of 1.31L (51% of predicted value) and a forced vital capacity of 3.74L (109% predicted). His gas transfer factor was moderately reduced (46% predicted), which was suggestive of emphysema.

Michael is being treated with short- and long-acting beta2 agonists in combination with inhaled corticosteroids, long-acting anti-cholinergic agents, and has been on prednisolone 15mg per day for a number of years.

His medication adherence and inhaler technique are both optimal.

He also has lumbar spine osteoporotic fractures and