A smoker with spirometrically confirmed COPD remains breathless despite smoking support, vaccination, pulmonary rehabilitation advice and a

Question

A smoker with spirometrically confirmed COPD remains breathless despite smoking support, vaccination, pulmonary rehabilitation advice and a short-acting bronchodilator. FEV₁ is 46% predicted, eosinophils are not raised, and there is no asthma, atopy or marked variability. Which maintenance inhaler should be offered?

Accepted Answer

Offer a LAMA plus LABA combination after checking and teaching inhaler technique

Answer

Offer a LAMA alone because dual bronchodilation is reserved for FEV₁ below 30% predicted

Answer

Offer a LAMA plus LABA plus inhaled corticosteroid before trying dual therapy because low FEV₁ mandates triple treatment

Answer

Offer a LABA plus inhaled corticosteroid because FEV₁ below 50% is itself evidence of steroid responsiveness

Answer

Offer inhaled corticosteroid monotherapy because recurrent breathlessness indicates airway inflammation

COPD — UKMLA MCQ