The FLAME trial demonstrated superiority of indacaterol/glycopyrronium (LABA/LAMA) over salmeterol/fluticasone (LABA/ICS) in reducing exacerbations in COPD. This landmark trial has influenced GOLD guidelines by supporting which treatment recommendation?
- A LABA/LAMA is preferred over LABA/ICS in most COPD patients without elevated blood eosinophil counts ✓
- B ICS/LABA is preferred over LABA/LAMA in all COPD patients
- C Triple therapy (ICS/LABA/LAMA) is first-line for all GOLD group B patients
- D ICS monotherapy is sufficient for group A patients
Correct answer: A. LABA/LAMA is preferred over LABA/ICS in most COPD patients without elevated blood eosinophil counts
Explanation
The FLAME trial (2016) showed that LABA/LAMA (indacaterol/glycopyrronium) reduced annual exacerbation rate by 11% compared with LABA/ICS, while also improving FEV1. This led GOLD guidelines to recommend LABA/LAMA as preferred dual therapy in most symptomatic COPD patients. ICS-containing regimens (LABA/ICS or triple) are preferred when blood eosinophils ≥300/μL, overlap with asthma features, or recurrent exacerbations despite LABA/LAMA. ICS overuse in COPD increases pneumonia risk.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.