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COPD inhaled steroid pneumonia risk — GPhC CRA MCQ

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HardRespiratory TherapeuticsCOPD inhaled steroid pneumonia riskGPhC CRA

A patient with COPD takes fluticasone/salmeterol, has had two radiologically confirmed pneumonias in 12 months, has blood eosinophils persistently below 0.1 × 10^9/L and has no asthma features. What is the best pharmacy recommendation?

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Correct answer: E — Arrange a structured review of ICS benefit, pneumonia risk and maintenance bronchodilation

Inhaled corticosteroids increase pneumonia risk in COPD, while expected benefit is shaped by exacerbation history, eosinophils and asthmatic features. Recurrent pneumonia and persistently low eosinophils therefore warrant a structured review of whether ICS remains justified and how bronchodilator therapy should be optimised. The pharmacist should not independently abandon maintenance bronchodilation, and neither oral steroid addition nor salbutamol-only treatment follows from the eosinophil result.

Reference: NICE NG115: COPD in over 16s — recommendations. https://www.nice.org.uk/guidance/ng115/chapter/Recommendations