A 62-year-old man with COPD (FEV1 38% predicted, 2+ exacerbations in past year, mMRC dyspnoea 3) is on LABA + LAMA + ICS triple therapy. Blood eosinophil count is 420 cells/µL. What treatment strategy is now supported by GINA/GOLD 2023 in this situation?
- A Add roflumilast (PDE-4 inhibitor) to existing triple therapy
- B Switch ICS component to budesonide and add N-acetylcysteine
- C Add dupilumab (anti-IL-4Rα) as first biologic for type-2 inflammation in COPD ✓
- D Add azithromycin prophylaxis for exacerbation prevention
Explanation
Dupilumab (anti-IL-4Rα) was approved by FDA in 2023 for COPD with type-2 airway inflammation (eosinophil count ≥300 cells/µL), based on the BOREAS and NOTUS Phase 3 trials showing significant reduction in exacerbation rates. It blocks both IL-4 and IL-13 signalling (shared IL-4Rα receptor) and is the first biologic approved for COPD. This patient has blood eosinophilia ≥300 cells/µL, making him a candidate. Roflumilast is an option for FEV1<50% with chronic bronchitis and exacerbations but does not specifically target type-2 inflammation. Azithromycin prophylaxis is used for frequent exacerbators but has ototoxicity risk and is not preferred over biologics in eosinophilic disease.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.