近年来大环内酯类药物的抗菌外作用及免疫调节作用越来越受到重视，已经成为哮喘、慢 性阻塞性肺疾病（简称慢阻肺）和支气管扩张症（简称支扩）等慢性呼吸道疾病治疗的重要选择。然而，临床上哪些患者更可能从治疗中获益，如何结合指南更规范的使用大环内酯类药物，减少可能带来的副作用，这给临床管理带来重大挑战。因此，本文结合英国胸科协会（BTS）指南，重点论述大环内酯类药物在慢性呼吸道疾病患者应用的适应证、主要依据、注意事项及未来需要重点考虑的问题。

In recent years，there has been much more interest in a non⁃antimicrobial action and immuno⁃ modulatory effects of macrolides，which have become an important choice for the treatment of asthma，chronic obstructive pulmonary disease（COPD）and bronchiectasis. However，which patients are more likely to benefit from the treatment，how to use macrolide drugs more standardized in combination with the guidelines，and reduce the possible side effects，which poses a major challenge to clinical management. Therefore，combined with the British Thoracic Society（BTS）guidelines，this article focuses on the indications，selection basis and future issues of macrolides in patients with chronic respiratory diseases.