A 55-year-old ex-smoker (40 pack-years) has COPD with FEV1 55% predicted, mMRC dyspnoea score 3, CAT score 22, and two exacerbations requiring hospitalisation in the past year. Per GOLD 2024 guidelines, the initial pharmacotherapy should be:

• A Short-acting beta-agonist (SABA) plus inhaled corticosteroid (ICS)
• B Dual long-acting bronchodilator (LABA + LAMA) combination ✓
• C LABA monotherapy alone
• D LABA + LAMA + ICS triple therapy immediately

Explanation

Per GOLD 2024, this patient falls in Group E (high symptom burden and ≥2 moderate exacerbations or ≥1 hospitalisation). Initial therapy for Group E is a LABA + LAMA dual bronchodilator combination. Escalation to triple therapy (LABA + LAMA + ICS) is considered if blood eosinophils are ≥300 cells/µL or if exacerbations persist on dual bronchodilator therapy. ICS monotherapy is not appropriate for COPD.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.