A 65-year-old man with COPD has FEV1 48% predicted, FEV1/FVC 0.58, mMRC dyspnea grade 3, and 2 moderate exacerbations in the past year. He is already on a long-acting bronchodilator. What is the recommended treatment escalation per GOLD 2023 guidelines?
- A Add a second LABA and continue current therapy
- B Add inhaled corticosteroid (ICS) to the existing LABA to form LABA+ICS dual therapy
- C Escalate to LABA + LAMA + ICS triple therapy given symptom burden and exacerbation history ✓
- D Start oral prednisolone long term
Correct answer: C. Escalate to LABA + LAMA + ICS triple therapy given symptom burden and exacerbation history
Explanation
Per GOLD 2023, patients in GOLD Group E (high symptom burden with exacerbations — the former GOLD D) who are on dual therapy (LABA+LAMA or LABA+ICS) and continue to have exacerbations should be escalated to triple inhaled therapy (LABA+LAMA+ICS). The IMPACT trial demonstrated that single-inhaler triple therapy (fluticasone furoate/umeclidinium/vilanterol) reduced moderate-to-severe exacerbations significantly compared to dual therapy. Long-term oral steroids are not recommended due to adverse effects. Blood eosinophil count (≥100 cells/μL) helps predict ICS response.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.