A 55-year-old male with COPD (GOLD Stage 3, CAT score 22, 2 exacerbations last year requiring hospitalisation) is on LABA/LAMA. His eosinophil count is 380 cells/µL. Per the 2023 GOLD guidelines, what is the most appropriate escalation?
- A Add roflumilast
- B Add inhaled corticosteroid (ICS) to form triple therapy ✓
- C Switch to LABA/ICS combination
- D Add oral prednisolone maintenance
Correct answer: B. Add inhaled corticosteroid (ICS) to form triple therapy
Explanation
Per GOLD 2023, adding ICS to LABA/LAMA (triple therapy) is recommended for COPD patients with persistent exacerbations (≥2 moderate or ≥1 hospitalisation) despite dual bronchodilators, especially when blood eosinophils ≥300 cells/µL. This patient has eosinophils 380/µL and repeated hospitalisations — ideal candidates for ICS addition. LABA/ICS without LAMA is a step-down. Roflumilast is indicated in chronic bronchitis phenotype (FEV1 <50%) but is not the first escalation. Maintenance oral corticosteroids are not recommended due to systemic side effects.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.