Chronic Obstructive Pulmonary Disease (COPD) affects at least 15 million Americans and is one of the leading cause of death in the U.S. COPD exacerbations lead to about 700,000 hospitalizations in the U.S. each year. Clinical trials and guidelines indicate that long-term use of either roflumilast or azithromycin significantly reduce the risk of COPD exacerbations. No studies to date have directly compared long-term roflumilast to azithromycin in patients with COPD, so it is unclear if one works better than the other. The COPD Foundation is co-leading this large pragmatic trial to evaluate long-term azithromycin vs. roflumilast for the prevention of COPD exacerbations. The RELIANCE study is currently enrolling. Check the website below to see if your institution is participating.