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COPD with frequent exacerbations — RCPSC IM MCQ

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HardRespirologyCOPD with frequent exacerbationsRCPSC IM

A 66-year-old woman with GOLD E COPD in Calgary has persistent dyspnoea despite tiotropium, salmeterol, and inhaled fluticasone. She has had three treated exacerbations in 12 months and one admission. Blood eosinophils are 0.38 x 10^9/L, FEV1 is 38 percent predicted, and oxygen saturation is 92 percent at rest. Sputum cultures are negative. What is the most appropriate management?

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Correct answer: D — Continue triple inhaled therapy and add roflumilast

Frequent exacerbations despite optimized inhaled triple therapy, severe airflow obstruction, and a chronic bronchitic phenotype support consideration of roflumilast. Long-term oxygen therapy is not indicated without severe resting hypoxaemia.

Reference: Canadian Thoracic Society COPD guidance