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Frequent COPD exacerbations — SCE Respiratory MCQ

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HardCOPDFrequent COPD exacerbationsSCE Respiratory

A 59-year-old woman with COPD has three infective exacerbations in 12 months despite LABA/LAMA/ICS, smoking cessation and pulmonary rehabilitation. Sputum cultures do not show Pseudomonas and ECG QTc is normal. Hearing is normal. What is the most appropriate management?

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Correct answer: D — Consider prophylactic azithromycin after specialist review

Selected COPD patients with frequent exacerbations despite optimised therapy may benefit from prophylactic azithromycin after specialist assessment and safety checks including QT interval and hearing. Long-term fluoroquinolone prophylaxis is not standard and carries substantial risk. Maintenance oral steroids are avoided because harms usually outweigh benefits.

Reference: NICE NG115 COPD; BTS long-term macrolide guidance