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COPD exacerbation prevention — SCE Respiratory MCQ

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ModerateCOPDCOPD exacerbation preventionSCE Respiratory

A 64-year-old woman with COPD remains breathless despite correct use of LAMA/LABA therapy and pulmonary rehabilitation. She has had three exacerbations needing prednisolone in the past year and one hospital admission. Blood eosinophils are 0.46 × 10^9/L on repeated samples; there is no pneumonia on chest radiograph. Post-bronchodilator FEV1 is 41% predicted. What is the most appropriate management?

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Correct answer: E — Add inhaled corticosteroid as part of triple therapy

Frequent exacerbations despite dual bronchodilation with raised eosinophils support escalation to inhaled corticosteroid-containing triple therapy. Maintenance oral prednisolone is not preferred because of systemic harm. Eosinophil count helps estimate the probability of exacerbation reduction from inhaled corticosteroids.

Reference: NICE NG115 COPD; GOLD 2025