Prophylactic azithromycin may reduce exacerbations in non-smokers, including ex-smokers, when all other interventions have been optimised, yet they continue to have one or more of the following:

• Frequent exacerbations with sputum production – typically four or more per year
• Prolonged exacerbations with sputum production
• Exacerbations resulting in hospitalisation.

Note that this therapy is outside of the product licence for azithromycin and requires monitoring before and during therapy.

As required’ low dose lorazepam (0.5 mg) and morphine sulphate liquid (2.5 mg), for anxiety and breathlessness respectively, are useful in end-stage disease when people may suffer panic attacks. More information on this can be found in the section on palliative care in the NICE guideline NG115, and the NICE Clinical Knowledge Summary scenario on end-stage COPD.