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Frequent COPD exacerbations — SCE Respiratory MCQ

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HardCOPDFrequent COPD exacerbationsSCE Respiratory

A 66-year-old man with COPD reports three exacerbations in 12 months despite smoking cessation, pulmonary rehabilitation and LABA/LAMA/ICS. FEV1 is 38% predicted. He has chronic productive cough, frequent winter admissions and no significant bronchiectasis on CT. Blood eosinophils are 0.08 x 10^9/L and QTc is normal. What is the most appropriate management?

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Correct answer: D — Consider prophylactic azithromycin after sputum culture, ECG and hearing assessment

In a carefully selected COPD patient with recurrent exacerbations despite optimised therapy, macrolide prophylaxis can be considered after excluding contraindications and assessing microbiology, QTc and hearing. Maintenance oral steroids are harmful in stable COPD and anti-IL-5 therapy is not standard COPD care. Nebulised bronchodilator alone and antifibrotics do not address this exacerbation phenotype.

Reference: NICE NG115; BTS Long-term Macrolide Guideline