A 60-year-old man with COPD (post-bronchodilator FEV1/FVC 0.58, FEV1 38% predicted) has had 2 hospitalizations for exacerbations in the past year despite dual bronchodilation (LAMA + LABA). Eosinophil count is 320 cells/µL. According to GOLD 2024, what should be added?

• A Add roflumilast (PDE-4 inhibitor)
• B Add azithromycin (macrolide maintenance)
• C Refer for lung volume reduction surgery
• D Add inhaled corticosteroid (ICS) — triple therapy ✓

Explanation

Per GOLD 2024, in COPD patients on dual bronchodilation (LABA+LAMA) who continue to have exacerbations, addition of ICS (triple therapy) is recommended when blood eosinophil count ≥300 cells/µL (or ≥100 cells/µL with ≥2 exacerbations). An eosinophil count of 320 cells/µL is a strong predictor of ICS response, reducing exacerbation frequency (IMPACT trial). Roflumilast is an add-on in chronic bronchitis phenotype with FEV1 <50% and ≥2 exacerbations, often used in combination. LVRS is reserved for selected emphysema-predominant patients with upper-lobe 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.