skip to main content

Malignant pleural mesothelioma — SCE Respiratory MCQ

Instant feedback + full explanation. One question, done properly.

HardPleural DiseaseMalignant pleural mesotheliomaSCE Respiratory

A patient without asthmatic features had a 3-month trial of LAMA+LABA+ICS after two COPD exacerbations. Breathlessness and exacerbation frequency are unchanged, adherence and technique are good, and pneumonia occurred during the trial. What should the inhaler review conclude?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Withdraw the inhaled corticosteroid and return to LAMA+LABA

Explanation lettering: C = shown as B · D = shown as C · B = shown as D

D is correct. NICE recommends documenting response to a trial of triple therapy; if symptoms or exacerbations do not improve, treatment should return to LAMA+LABA. Pneumonia further weighs against unnecessary ICS exposure in a patient without asthmatic features. ICS monotherapy, automatic dose escalation and maintenance oral corticosteroids are not appropriate alternatives, while an ineffective trial need not be continued indefinitely.

Reference: https://www.nice.org.uk/guidance/ng115/chapter/Recommendations