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COPD Frequent Exacerbations — RACP Adult Medicine MCQ

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HardRespiratoryCOPD Frequent ExacerbationsRACP Adult Medicine

A 60-year-old man with known COPD (FEV1 35% predicted) on triple inhaler therapy (ICS/LABA/LAMA) continues to have frequent exacerbations (4 in the past year). His blood eosinophil count is 80 cells/µL. What additional therapy should be considered?

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Correct answer: B — Long-term azithromycin

For COPD patients with frequent exacerbations despite maximal inhaler therapy and LOW blood eosinophils (<100 cells/µL), long-term low-dose azithromycin (250 mg daily or 500 mg three times weekly) reduces exacerbation frequency. An ECG should be checked for QTc prolongation, and NTM culture performed before commencing. If eosinophils were >300, roflumilast would be considered. In low-eosinophil patients, ICS may be stepped down.

Reference: Lung Foundation Australia/TSANZ – 2025 – COPD-X Plan V2.78; GOLD – 2025 – COPD Report