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ICS pneumonia risk in COPD — GPhC CRA MCQ

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HardRespiratory TherapeuticsICS pneumonia risk in COPDGPhC CRA

A patient has post-bronchodilator FEV1 42% predicted, chronic productive cough and three treated COPD exacerbations in the past year despite confirmed adherence to LABA/LAMA/ICS triple therapy. Smoking cessation and technique have been addressed. Which additional option is specifically supported by NICE?

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Correct answer: B — Specialist initiation of roflumilast should be considered

NICE identifies roflumilast as an option for severe COPD associated with chronic bronchitis when there have been at least two exacerbations in the preceding year despite triple inhaled therapy; treatment is started by a specialist. This patient meets those features. A community pharmacist should not initiate it independently. Low FEV1 alone is not a reason to remove ICS, and oral beta2-agonist monotherapy is not a substitute for optimised inhaled treatment. LTOT is based on stable hypoxaemia confirmed by formal assessment, not exacerbation count.

Reference: NICE NG115: COPD diagnosis and management. https://www.nice.org.uk/guidance/ng115/chapter/Recommendations