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COPD with recurrent exacerbations — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareCOPD with recurrent exacerbationsUSMLE Step 3

A 67-year-old man with COPD comes to clinic 6 weeks after his second treated exacerbation this year. He uses a LAMA/LABA inhaler, has good technique, and no history of asthma. Blood eosinophil count is 360/microL. Spirometry shows FEV1/FVC 0.55. He quit smoking 3 years ago. Which of the following would you recommend at the follow-up visit?

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Correct answer: B — Escalate to inhaled triple therapy

Patients with COPD who have recurrent exacerbations despite LAMA/LABA and higher eosinophil counts are more likely to benefit from adding inhaled corticosteroid therapy as part of triple therapy.

Reference: GOLD COPD strategy