A 72-year-old man with COPD (FEV1 45% predicted) is already on a long-acting muscarinic antagonist (LAMA) inhaler. He remains symptomatic with mMRC dy...

Question

A 72-year-old man with COPD (FEV1 45% predicted) is already on a long-acting muscarinic antagonist (LAMA) inhaler. He remains symptomatic with mMRC dyspnoea score 3 and has had two moderate exacerbations requiring oral steroids in the last year. What is the most appropriate pharmacological escalation?

Accepted Answer

Add a long-acting beta₂-agonist to create dual LABA/LAMA therapy

Answer

Add an inhaled corticosteroid alone

Answer

Switch LAMA to short-acting beta₂-agonist

Answer

Start chronic macrolide therapy

Answer

Start long-term oral prednisolone 10 mg daily

au-racp MCQ (SBA): Chronic obstructive pulmonary disease