skip to main content

Smoking Cessation COPD — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

EasyRespiratorySmoking Cessation COPDRACP Adult Medicine

A 60-year-old smoker (40 pack-years) presents with progressive dyspnoea. Spirometry: FEV₁ 38% predicted, FVC 72%, FEV₁/FVC 0.42. Post-bronchodilator: FEV₁ improves by 80 mL (5%). DLCO 40%. CT shows panlobular emphysema with bullae. He is still smoking. What is the single most important intervention?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Smoking cessation

Smoking cessation is the ONLY intervention proven to slow FEV₁ decline and improve survival in COPD (Fletcher-Peto curve). All other therapies (bronchodilators, ICS, O₂, rehab) improve symptoms and reduce exacerbations but do NOT alter the natural history as effectively as quitting. Pharmacological smoking cessation: varenicline (most effective single agent, NNT ~8), nicotine replacement therapy, or bupropion. Combine with behavioural support (Quitline, counselling).

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