Multiple treatments are available for chronic obstructive pulmonary disease (COPD), but identifying which regimen best matches an individual patient’s needs remains one of the biggest challenges in care. A new study from researchers at UCLA Health compares two treatment options aimed at preventing exacerbations in patients with COPD.
A COPD exacerbation is an acute worsening of symptoms (e.g., cough, shortness of breath) that is associated with reduced quality of life, declines in lung function, and increased risks of mortality. For patients who experience frequent exacerbations while on maximal inhaler therapy, clinical guidelines recommend one of two treatment options: azithromycin or roflumilast.
“While both treatments have been found to reduce exacerbations, there has been little data available to guide clinicians about which option is best,” said Dr. William Feldman, a pulmonologist and health services researcher at UCLA Health and senior author of the study. “Our findings help fill that gap by providing data that can better inform treatment decisions.”
According to the new study, published in BMJ, maintenance azithromycin, taken as long-term preventive therapy to prevent future flare-ups, seemed to perform slightly better than roflumilast in protecting against COPD exacerbations. Patients taking azithromycin had a 17% lower risk of experiencing their first moderate or severe flare-up; an 11% lower rate of flare-ups over one year of follow-up; and a slightly lower risk (6%) of being hospitalized or dying from any cause compared to roflumilast.
These differences were observed in two distinct study populations: a broad group of patients with varying COPD severity and a narrower group of patients with more severe COPD.
As a part of this study, researchers pulled data from a large longitudinal healthcare database, identifying patients from 2011-2024 who filled new prescriptions for maintenance azithromycin or roflumilast. The authors adjusted for a wide range of covariates to ensure that the two groups were well-balanced across various measures. A total of 7,550 matched pairs of patients were included in the primary analysis. The findings of this study highlight differences in treatment effectiveness that may help guide clinical decision making when considered alongside safety evidence and forthcoming data from a large randomized controlled trial.
“Living with COPD can have a profound impact on patients’ quality of life,” Feldman said. “It’s critical that we generate better evidence to help patients and clinicians choose the most effective treatment regimens. Our hope is that this study can add to the growing body of research to help clinicians deliver the best possible care for patients.”
Article citation: http://doi.org/10.1136/bmj-2026-100111
