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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 38% predicted, two exacerbations in the past year) is currently taking tiotropium and salbutamol. He remains breathless on minimal exertion. His eosinophil count is 350 cells/microlitre. What is the most appropriate addition to his therapy?

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Correct answer: B — Add a combined LABA/inhaled corticosteroid (ICS) inhaler

NICE NG115 recommends adding a LABA/ICS combination inhaler for COPD patients who remain symptomatic on a LAMA (tiotropium) and have had two or more exacerbations in the past year, particularly if the blood eosinophil count is 300 cells/microlitre or above. The eosinophil count helps guide whether ICS is likely to be beneficial. Prophylactic azithromycin may be considered later if exacerbations persist despite optimised inhaler therapy.

Reference: NICE NG115 COPD; BNF