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Chronic obstructive pulmonary disease — RACGP Fellowship MCQ

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HardChronic disease managementChronic obstructive pulmonary diseaseRACGP Fellowship

A 67‑year‑old man with COPD attends for routine review. He has had two infective exacerbations in the past year requiring oral corticosteroid courses. Spirometry confirmed fixed airflow obstruction. He continues to experience breathlessness on exertion despite using only a short‑acting bronchodilator. What is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: A — Initiate a long‑acting inhaled bronchodilator and reassess inhaler technique

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

This patient remains breathless on exertion despite short‑acting bronchodilator use and has had two exacerbations in the past year. The Australian COPD‑X stepwise algorithm recommends adding a long‑acting inhaled bronchodilator (LABA or LAMA) at this stage and ensuring inhaler technique is correct. Long‑term oral corticosteroids (A) expose to systemic toxicity and are not recommended. Continuous prophylactic antibiotics (B) are not standard and are only indicated during acute infective exacerbations. Stopping bronchodilators (C) is incorrect: irreversible obstruction does not preclude benefit from bronchodilators. Early referral for lung volume reduction (E) is inappropriate before optimising medical therapy.

Reference: Australian Prescriber. Establishing a national standard to achieve better outcomes for people living with chronic obstructive pulmonary disease (COPD‑X). December 2024. URL above. https://australianprescriber.tg.org.au/articles/establishing-a-national-standard-to-achieve-better-outcomes-for-people-living-with-chronic-obstructive-pulmonary-disease.html