A 66-year-old man with COPD (post-bronchodilator FEV1/FVC 0.62, FEV1 52% predicted) has had 2 moderate exacerbations in the past year and is on a long-acting beta2-agonist (LABA). CAT score is 18. According to GOLD 2023, what is the RECOMMENDED treatment escalation?
- A Add inhaled corticosteroid (ICS) directly to LABA
- B Add long-acting muscarinic antagonist (LAMA) to form LABA/LAMA dual bronchodilation ✓
- C Start oral prednisolone maintenance
- D Add roflumilast and azithromycin prophylaxis
Correct answer: B. Add long-acting muscarinic antagonist (LAMA) to form LABA/LAMA dual bronchodilation
Explanation
Per GOLD 2023, for COPD group E (high symptom burden + exacerbation risk), initial escalation from monotherapy is to LABA/LAMA dual bronchodilation, which has greater bronchodilator efficacy than either monotherapy. ICS is added (triple therapy: LABA/LAMA/ICS) when eosinophil count ≥300 cells/µL or in patients with frequent exacerbations despite LABA/LAMA. Oral corticosteroids are not used for maintenance. Roflumilast and azithromycin are adjuncts for selected patients with chronic bronchitis and very frequent exacerbations.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.