Large-scale quantum effects have always played an important role in the foundations of quantum theory. With recent experimental progress and the aspiration for quantum enhanced applications, the interest in macroscopic quantum effects has been reinforced. In this review, measures aiming to quantify various aspects of macroscopic quantumness are critically analyzed and discussed. Recent results on the difficulties and prospects to create, maintain, and detect macroscopic quantum states are surveyed. The role of macroscopic quantum states in foundational questions as well as practical applications is outlined. Finally, past and ongoing experimental advances aiming to generate and observe macroscopic quantum states are presented.