Objective: To systematically review the efficacy of long-term use of azithromycin in the treatment of chronic obstructive pulmonary disease（COPD） in stable stage. Methods: PubMed

Embase

The Cochrane Library

Web of Science

CNKI

and Wanfang Data were searched for randomized controlled trials（RCTs） of long-term use of azithromycin in the treatment of COPD in stable stage published up to August 1

2019. Two reviewers independently screened the literature

extracted data

and assessed the risk of bias of included studies

and then R studio（version3.5.1） was used to perform the meta-analysis. Results: A total of 30 RCTs with 2 726 patients were included. The results of the meta-analysis showed that compared with the control group

the long-term azithromycin group had significant improvement in pulmonary function

with significant increases in ratio of forced expiratory volume in 1 second to forced vital capacity（mean difference [MD] = 0.85

95% confidence interval [CI]: 0.46 ～ 1.24

P < 0.01）

forced expiratory volume in 1 second（MD = 0.81

95% CI: 0.45 ～ 1.17

P < 0.01）

predicted percentage of forced expiratory volume in 1 second（MD = 0.60

95% CI: 0.31 ～ 0.88

P < 0.01）

and 6-minute walk test distance（MD = 1.83

95%CI: 1.13 ～ 2.54

P < 0.01） and a significant reduction in the score of St George’s Respiratory Questionnaire（MD =-0.88

95% CI:-1.70 to-0.08

P = 0.03）. Conclusion: Longterm use of azithromycin can effectively improve COPD patients’ pulmonary function

exercise tolerance

and quality of life. Due to the limited quality and quantity of the included studies

more high-quality studies are needed to verify the above conclusion.