A 67-year-old woman is reviewed in a specialist COPD clinic. She has chronic productive cough and post-bronchodilator FEV1 42% predicted. During the

Question

A 67-year-old woman is reviewed in a specialist COPD clinic. She has chronic productive cough and post-bronchodilator FEV1 42% predicted. During the previous 12 months she has had three COPD exacerbations requiring prednisolone and antibiotics, including one hospital admission, despite verified adherence to LAMA/LABA/ICS therapy, satisfactory inhaler technique, smoking cessation and pulmonary rehabilitation. She weighs 52 kg with a stable BMI of 18.1 kg/m². Her eGFR is 24 mL/min/1.73 m². Liver biochemistry and synthetic function are normal. Ten years ago she had a depressive episode without suicidal ideation or behaviour; she has been asymptomatic without antidepressant treatment for 8 years. She has no current mood disturbance and understands the need to report neuropsychiatric symptoms. After discussion of benefits and adverse effects, she wishes to proceed with roflumilast. Which roflumilast prescribing plan is most appropriate?

Accepted Answer

Initiate 250 micrograms once daily for 28 days, then 500 micrograms once daily, with weight and mood monitoring

Answer

Initiate 500 micrograms once daily from the outset, with weight and mood monitoring

Answer

Defer treatment because severe renal impairment precludes roflumilast therapy

Answer

Initiate 250 micrograms once daily as long-term maintenance, with weight and mood monitoring

Answer

Defer treatment because a previous depressive episode precludes roflumilast therapy

Severe COPD with chronic bronchitis and frequent exacerbations — SCE Respiratory MCQ