A 65-year-old ex-smoker with COPD (post-bronchodilator FEV1/FVC 0.62, FEV1 48% predicted) has had 3 exacerbations in the past year, CAT score 18, and blood eosinophils of 380 cells/μL. According to GOLD 2023 guidelines, what is the MOST appropriate initial pharmacotherapy?
- A Triple therapy: LABA + LAMA + ICS ✓
- B LAMA alone (tiotropium)
- C LABA + ICS dual therapy
- D LABA + LAMA dual therapy
Correct answer: A. Triple therapy: LABA + LAMA + ICS
Explanation
GOLD 2023 Group E (high exacerbation risk) with blood eosinophils ≥300 cells/μL strongly predicts ICS response. For Group E patients, triple therapy (LABA + LAMA + ICS) is the preferred initial treatment, particularly when eosinophils are elevated. LABA+LAMA is appropriate for Group E patients with lower eosinophil counts (<100 cells/μL). ICS+LABA alone is no longer preferred over triple therapy for Group E per GOLD 2023.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.