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COPD — RACP Adult Medicine MCQ

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HardRespiratoryCOPDRACP Adult Medicine

A patient has persistent symptoms and two prednisolone-requiring exacerbations despite verified adherence, correct technique and high-dose ICS-formoterol maintenance-and-reliever therapy. Spirometry confirms variable obstruction and blood eosinophils are repeatedly 0.65 × 10^9/L. What is the best next step?

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Correct answer: A — Refer for severe-asthma phenotyping and biologic eligibility assessment

Explanation lettering: C = shown as A · E = shown as B · A = shown as C · B = shown as E

C is correct. Confirmed severe eosinophilic asthma despite optimised therapy warrants specialist phenotyping and biologic assessment. D duplicates LABA and creates toxicity. E reverses the implication of eosinophilia. A exposes the patient to avoidable systemic harm before steroid-sparing assessment. B ignores documented variability and phenotype.

Reference: Australian Asthma Handbook, Specialist assessment and treatment for severe asthma: https://www.asthmahandbook.org.au/management/adults-and-adolescents/medication-management/specialist-assessment-and-treatment-for-severe-asthma-in-adults-and-adolescents