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Obstructive sleep apnoea — CCFP MCQ

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HardChronic disease managementObstructive sleep apnoeaCCFP

A patient with COPD has two treated exacerbations in the past year despite good adherence and technique with LAMA-LABA. Blood eosinophils are 350 cells/microlitre and there is no pneumonia history. What is the next inhaled-treatment step?

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Correct answer: E — Escalate to LAMA-LABA-ICS and reassess exacerbations, pneumonia and technique

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

A is correct. Recurrent exacerbations on dual bronchodilation with a high eosinophil count favour escalation to triple inhaled therapy, with follow-up for response and pneumonia. B removes effective bronchodilation and uses unsupported steroid monotherapy. C causes major chronic systemic-steroid harm. D ignores a useful predictor of corticosteroid response. E substitutes short-acting relief for maintenance prevention. Smoking treatment, vaccination, pulmonary rehabilitation and diagnostic review remain essential.

Reference: Canadian Thoracic Society: Pharmacotherapy in stable COPD: https://cts-sct.ca/wp-content/uploads/2023/09/2023-CTS-COPD-Pharmacotherapy-Guideline-1.pdf