Macrolide Maintenance Therapy in Chronic Obstructive Pulmonary Disease

Inclusion Criteria: * Diagnosis of COPD according to GOLD criteria (FEV1/FVC\<70%), classification into GOLD I (FEV1 70-100% predicted), GOLD II (FEV1 50-70% predicted), GOLD III (FEV1 30- 50% predicted) or GOLD IV (FEV1 ≤ 30% predicted) * Age ≥ 18 years * Three or more exacerbations of COPD in one year for which a course of prednisone and/or antibiotic therapy was started * Clinically stable during 1 month. Patients have to be free of COPD exacerbation or respiratory tract infection within a month prior to involvement in the study and they should not have received a high dose of systemic glucocorticoids or antibiotics in this period * Informed consent Exclusion Criteria: * Use of antibiotics or high dose of systemic steroids within a month prior to involvement in the study. * Addition of inhalation steroids to the patient's therapy regimen, shortly before entering the study. * Pregnant or lactating women. * Allergy to macrolides. * Liver disease (alanine transaminase and/or aspartate transaminase levels 2 or more times the upper limit of normal). * Asthma, defined as episodic symptoms of airflow obstruction which is reversible with bronchodilators, assessed with lung function testing. * Presence of a malignancy which is clinically active. * Bronchiectasis. * Malignancy of any kind for which the subject is under treatment or is being monitored as part of follow up after treatment. * Heart failure. * Use of drugs which can adversely interact with macrolides and for which therapeutic monitoring cannot be undertaken.