The GOLD 2023 strategy for initial pharmacological treatment of COPD now recommends spirometry-confirmed diagnosis followed by symptom/risk group stratification. For a patient with mMRC breathlessness score 3 and no exacerbations in the past year (Group B), what is the preferred initial bronchodilator therapy?

• A Short-acting beta-2 agonist (SABA) alone as needed
• B Long-acting muscarinic antagonist (LAMA) alone
• C LAMA + LABA + inhaled corticosteroid triple therapy
• D LAMA + LABA dual bronchodilator therapy ✓

Explanation

GOLD 2023 guidelines simplified COPD pharmacological management and recommend dual bronchodilator (LAMA + LABA) as the preferred initial therapy for Group B patients (high symptom burden, mMRC ≥2 or CAT ≥10, low exacerbation risk), based on evidence from the EMAX and PINNACLE trials showing LAMA+LABA superiority over monotherapy for symptom relief. SABA alone is no longer recommended as the initial treatment. Triple therapy (LAMA+LABA+ICS) is for Group E (high exacerbation risk) or those with eosinophil count ≥300 cells/µL.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.