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COPD — RACP Adult Medicine MCQ

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ModerateRespiratoryCOPDRACP Adult Medicine

A 62-year-old woman with COPD (FEV₁ 65% predicted) has infrequent exacerbations (one mild exacerbation in 12 months) but significant daily dyspnoea limiting activity. She is currently on SABA PRN. Her blood eosinophil count is 90 cells/μL. What is the most appropriate step-up?

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Correct answer: B — LAMA + LABA combination

With predominant symptoms but infrequent exacerbations and low eosinophils (<300), LAMA + LABA is preferred over ICS-containing regimens. ICS provides minimal benefit with eosinophils <100 and increases pneumonia risk. Dual bronchodilator therapy addresses the symptom burden more effectively.

Reference: COPD-X Australian/NZ Guidelines 2024; GOLD 2025