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COPD Triple Therapy — RACP Adult Medicine MCQ

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ModerateRespiratoryCOPD Triple TherapyRACP Adult Medicine

A 50-year-old woman with COPD presents with 2 AECOPD in the past year requiring oral steroids. She is on LAMA/LABA (umeclidinium/vilanterol). Eosinophil count is 350 cells/μL. FEV₁ is 42%. She has no features of asthma. What is the most appropriate treatment escalation?

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Correct answer: C — Add ICS to LAMA/LABA (triple therapy)

COPD with ≥2 moderate exacerbations/year (or ≥1 hospitalisation) despite LAMA/LABA AND blood eosinophils ≥300 → add ICS (step up to triple therapy: ICS/LAMA/LABA). GOLD 2025 uses eosinophil thresholds: ≥300 = likely to benefit from ICS, <100 = unlikely. If eos <100 with frequent exacerbations: azithromycin prophylaxis or roflumilast (if FEV₁<50% with chronic bronchitis phenotype) instead of ICS.

Reference: COPD-X 2024; GOLD 2025; IMPACT Trial