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Frequent COPD exacerbations — SCE Respiratory MCQ

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HardCOPDFrequent COPD exacerbationsSCE Respiratory

A 73-year-old man with severe COPD has four infective exacerbations in 10 months despite LAMA/LABA/ICS and pulmonary rehabilitation. Sputum cultures repeatedly grow Haemophilus influenzae, ECG QTc is normal, and baseline audiometry shows no significant impairment. CT chest shows emphysema without bronchiectasis. He has never grown Pseudomonas aeruginosa. What is the most appropriate management?

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Correct answer: B — Consider long-term azithromycin after specialist review

Long-term azithromycin can be considered in selected COPD patients with frequent exacerbations despite optimised care, after ECG, hearing and microbiology review. Inhaled colistin is more relevant to bronchiectasis with chronic Pseudomonas infection. Before macrolides, clinicians should check QT risk, hearing and non-tuberculous mycobacteria considerations.

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