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Asthma-COPD overlap — SCE Respiratory MCQ

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HardAirways diseaseAsthma-COPD overlapSCE Respiratory

A 59-year-old woman has a 25 pack-year smoking history, childhood eczema and adult-onset wheeze. Post-bronchodilator FEV1/FVC is 0.56 with FEV1 reversibility of 510 mL; FeNO is 58 ppb and eosinophils are 0.42 x 10^9/L. She has two steroid-responsive exacerbations each year. What is the most appropriate management?

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Correct answer: B — Include inhaled corticosteroid in long-acting inhaled therapy

Persistent obstruction suggests COPD, but marked reversibility and type 2 biomarkers indicate asthmatic features, so an ICS-containing long-acting regimen is appropriate. LAMA monotherapy would under-treat the inflammatory asthma component. Maintenance oral steroids are not a routine substitute for optimised inhaled treatment.

Reference: NICE NG115 COPD; BTS/NICE/SIGN Asthma Guideline 2024