A 60-year-old ex-smoker with COPD has FEV1 40% predicted, CAT score 22, and two exacerbations requiring hospitalization in the past year. According to GOLD 2023 guidelines, which pharmacological regimen is recommended at this stage?
- A LABA monotherapy
- B LAMA monotherapy
- C Triple therapy: LAMA + LABA + inhaled corticosteroid (ICS) ✓
- D ICS alone
Correct answer: C. Triple therapy: LAMA + LABA + inhaled corticosteroid (ICS)
Explanation
GOLD 2023 classifies this patient as GOLD Group E (frequent exacerbations ≥ 2 moderate or ≥ 1 hospitalisation). For Group E patients, GOLD recommends initiating with LAMA + LABA combination, with escalation to triple therapy (LAMA + LABA + ICS) if exacerbations continue, especially with blood eosinophils ≥ 100/µL. The IMPACT and ETHOS trials support triple therapy in frequent exacerbators. ICS monotherapy has no role. LABA or LAMA monotherapy is insufficient for this high-risk patient.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.