Thoughts on a seasonal prophylactic of azithromycin (winter) for COPD an history of bronchitis?

Some support. If the patient has frequent COPD exacerbations first step is to maximize inhaled therapy with a Long acting antimuscarinic like and an ICS/LABA such as all three classes of drugs lower the exacerbation rate. Beyond this there is some support for Chronic azithromycin therapy especially in older patients who don't smoke, and support for roflumulast which also decreases risk but has GI side effects.