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Effect of Prophylactic Azithromycin Use in Chronic Obstructive Pulmonary DiseaseIntroductionAcute exacerbations of chronic obstructive pulmonary disease AECOPD orlung attacks result in irreversible disease progression and account forthe highest rate of hospital combined admissions and readmissions amongother chronic illnesses Within a year one out of every six dischargedCOPD patients will be readmitted once and one out of every seven will bereadmitted twice 1 This makes COPD the leading trigger for readmissionsamong all causes of unplanned readmissions into Canadian hospitals 1Mittman et al conservatively estimated and predicted the annualhospitalization costs hospital stay treatments diagnostics andtransportation of COPD in 2015 in Canada to be 1 billion around 900million US dollars 2 Not only are the admission and readmission rateshigh but even mortality is surprisingly still increasing Althoughadvancements in medicine have dramatically brought down deaths fromcoronary artery disease stroke and hypertension over the past 40 yearsCOPD remains the only chronic disease with increasing mortality rates 34 One in four COPD patients dies within a year of being hospitalized and8 die in hospitals 5 In spite of all this research in the field of COPD is lacking behindin finding new therapies to reduce or prevent exacerbations However a fewrecent trials looked at using prophylactic azithromycin to reduce AECOPDwhich presents a need to evaluate and compare the benefits of this approachto the regular standard of care for COPD patients Prophylactic macrolide therapy has been evaluated in multiplerespiratory conditions such as cystic fibrosis 6 bronchiectasis 7 anddiffuse panbronchiolitis 8 Prophylactic macrolides have been assessed inthose respiratory conditions due to their combined antibacterial anti-inflammatory and immunomodulating activity 9 Shinkai et al reportedthe many potential immunomodulatory effects of macrolides such as down-regulating prolonged inflammation inhibiting bacterial biofilm formationdecreasing
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