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COPD exacerbation prevention — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)COPD exacerbation preventionUSMLE Step 3

A 70-year-old man with COPD has progressive dyspnea. He uses tiotropium and albuterol. He has had two exacerbations requiring prednisone in the past year. Blood eosinophils are 340/mm3. FEV1 is 45% predicted. He quit smoking 5 years ago. Which of the following is the most appropriate next step in management?

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Correct answer: A — Add inhaled corticosteroid/long-acting beta-agonist therapy

Frequent COPD exacerbations despite long-acting bronchodilator therapy and elevated eosinophils support escalation to inhaled corticosteroid-containing therapy. Chronic systemic steroids are avoided because harms exceed benefits.

Reference: GOLD COPD Strategy Report