ICS pneumonia risk in COPD — GPhC CRA MCQ
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Correct answer: D — Review ICS benefit against exacerbations, steroid-responsive features, technique and pneumonia risk
NICE requires discussion of inhaled-corticosteroid adverse effects, including pneumonia. Recurrent pneumonia should trigger review of the ICS indication, exacerbation history, eosinophilic or asthmatic features, technique and overall regimen. It does not prove the ICS must be stopped abruptly, and any step-down should be planned and monitored. Tiotropium is not the obvious medicine to withdraw for this reason.
Reference: NICE NG115: Chronic obstructive pulmonary disease: https://www.nice.org.uk/guidance/ng115/chapter/Recommendations