Azithromycin COPD Prophylaxis — RACP Adult Medicine MCQ

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

HardRespiratoryAzithromycin COPD ProphylaxisRACP Adult Medicine

A 55-year-old man with COPD (FEV₁ 35%) on ICS/LAMA/LABA triple therapy has recurrent exacerbations (3 in past year). Eosinophils are persistently <100 cells/μL. He has chronic productive cough (chronic bronchitis phenotype). He is a non-smoker (quit 10 years ago). Sputum grows H. influenzae. What is the most appropriate additional intervention?

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

Reveal the answer and explanation

Correct answer: C — Add azithromycin prophylaxis

Frequent exacerbations on triple therapy with low eosinophils and chronic bronchitis: azithromycin prophylaxis (250 mg daily or 500 mg 3×/week) reduces exacerbation frequency by ~30% (COLUMBUS trial). Check baseline ECG (QT prolongation risk), LFTs, and hearing. NTM culture before starting (azithromycin monotherapy promotes NTM resistance). Alternative: roflumilast (PDE4 inhibitor) if FEV₁ <50% with chronic bronchitis phenotype and frequent exacerbations.

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