In COPD management, GOLD 2023 guidelines recommend initiating dual bronchodilation (LABA + LAMA) rather than LABA + ICS as a preferred first-line combination in which patient group?
- A Patients with persistent dyspnoea and exacerbations without blood eosinophils ≥300 cells/µL ✓
- B All patients regardless of eosinophil count at initial presentation
- C Patients with concomitant asthma-COPD overlap (ACO)
- D Patients with FEV1 < 30% predicted only
Correct answer: A. Patients with persistent dyspnoea and exacerbations without blood eosinophils ≥300 cells/µL
Explanation
GOLD 2023 recommends LABA + LAMA as preferred initial combination therapy for most patients needing dual bronchodilation. ICS addition is guided by blood eosinophils: eosinophils ≥300 cells/µL predict ICS benefit; eosinophils <100 cells/µL predict ICS lack of benefit and increased pneumonia risk. ACO (asthma-COPD overlap) does warrant ICS. The IMPACT trial confirmed that triple therapy (LABA + LAMA + ICS) with blood eosinophils ≥150 cells/µL reduces exacerbations. Eosinophil-guided ICS therapy is a major GOLD 2023 update.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.