Many studies on macrolide immunomodulatory properties in the treatment of chronic pulmonary disorders reveal dependable positive outcomes, and these effects, accompanied by their inhibitory action on biofilms, have the prospective to make them a useful alternative. The stimulation of gastrointestinal motility, a frequent macrolide side-effect, may be beneficial in patients with deprived gut motility. There are also initial data suggesting that the currently available macrolide antibiotics possess anti-tumour activity. The purpose of this review is to abridge existing evidence on the effects of macrolides beyond their antimicrobial activity. We believe this issue is of great interest to many physicians, mainly those engaged with the care of patients suffering from chronic inflammatory pulmonary diseases. Therefore, we have carried out a systematic search in the medical literature focusing on the mechanisms by which this class of antibiotics exerts these valuable immunomodulating effects and their influence on the management of certain human medical conditions.