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COPD ICS Escalation — RACP Adult Medicine MCQ

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ModerateRespiratoryCOPD ICS EscalationRACP Adult Medicine

A 68-year-old man with COPD on umeclidinium/vilanterol (LAMA/LABA) has blood eosinophils of 350 cells/µL and has had 2 exacerbations in the past year requiring hospitalisation. According to GOLD 2025, what therapeutic change is indicated?

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Correct answer: B — Continue current therapy – no change needed

For COPD patients on LABA/LAMA with persistent exacerbations and blood eosinophils ≥300 cells/µL, escalation to triple therapy (ICS/LABA/LAMA) is recommended per GOLD 2025 and COPD-X guidelines. The eosinophil count guides whether to add ICS: ≥300 cells/µL favours ICS addition; <100 cells/µL suggests ICS is unlikely to benefit (consider azithromycin or roflumilast instead). The IMPACT and ETHOS trials demonstrated reduced exacerbations with triple therapy vs dual in eosinophilic COPD.

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