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COPD escalation with eosinophils — GPhC CRA MCQ

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HardRespiratory TherapeuticsCOPD escalation with eosinophilsGPhC CRA

A 55-year-old man with COPD (FEV1 45% predicted) has had two exacerbations in the past year requiring oral corticosteroids. He is currently taking a LAMA inhaler only. His blood eosinophil count is 350 cells/microlitre. According to NICE NG115, what is the most appropriate step-up?

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Correct answer: C — Add a LABA and ICS combination inhaler

NICE NG115 recommends that in patients with COPD who have exacerbations despite LAMA monotherapy, the next step depends on eosinophil count. With blood eosinophils ≥300 cells/microlitre, a LABA+ICS combination should be added to the LAMA (triple therapy). Eosinophils are an important biomarker for ICS responsiveness in COPD. Theophylline, azithromycin, and roflumilast are reserved for later steps after optimising inhaler therapy.

Reference: NICE NG115 COPD; GOLD 2024