A 62-year-old ex-smoker with COPD (post-bronchodilator FEV1/FVC 0.58, FEV1 42% predicted) has had 3 exacerbations in the past year. He is currently on a LAMA alone. Which maintenance regimen is most appropriate according to GOLD 2024 guidelines?
- A LABA + LAMA without ICS
- B Oral theophylline
- C Triple inhaled therapy: ICS + LABA + LAMA ✓
- D High-dose inhaled ICS alone
Correct answer: C. Triple inhaled therapy: ICS + LABA + LAMA
Explanation
GOLD 2024 guidelines recommend escalation to triple inhaled therapy (ICS/LABA/LAMA) in GOLD Group E patients (≥2 exacerbations or ≥1 hospitalisation per year) inadequately controlled on dual bronchodilation. The IMPACT and ETHOS trials demonstrated that triple therapy significantly reduces exacerbations and improves FEV1 compared with dual LABA/LAMA or ICS/LABA. Elevated eosinophils (≥300 cells/µL) further support ICS addition. Theophylline has a narrow therapeutic window and limited evidence. ICS monotherapy is not recommended in 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.