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Frequent COPD exacerbations — SCE Respiratory MCQ

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ModerateCOPDFrequent COPD exacerbationsSCE Respiratory

A 74-year-old woman with COPD has FEV1 38% predicted and three exacerbations in 9 months despite LABA/LAMA/ICS. She has no bronchiectasis on CT, sputum cultures are repeatedly negative and QTc is normal. She has stopped smoking and completed pulmonary rehabilitation. What is the most appropriate management?

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Correct answer: C — Consider prophylactic azithromycin after specialist risk assessment

Selected COPD patients with frequent exacerbations despite optimised treatment may benefit from prophylactic azithromycin after checking QT interval, hearing and sputum microbiology. Long-term oral prednisolone is avoided because of systemic harm. Oxygen therapy requires hypoxaemia assessment, and pleurodesis is irrelevant.

Reference: NICE NG115; BNF