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ICS pneumonia risk in COPD — GPhC CRA MCQ

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HardRespiratory TherapeuticsICS pneumonia risk in COPDGPhC CRA

A 74-year-old with COPD takes fluticasone/salmeterol plus tiotropium and has had two pneumonias in 12 months. Which medication review is most appropriate?

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Correct answer: DReview 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