QuestionSBA
QuestionChoice
This would be the next best step if there were asthmatic features or features suggesting steroid-responsiveness.
10005285
e
Combined long-acting beta 2 agonist and inhaled corticosteroid
QuestionChoice
According to the relevant 2018 NICE guideline, this should be combined with a long-acting muscarinic antagonist (such as ipratropium) for optimum control.
10005282
b
Long-acting beta 2 agonist
QuestionChoice
Following the 2018 NICE guidelines, the next step in management would be a combined long-acting beta 2 agonist (such as salmeterol) + a long-acting muscarinic antagonist (such as ipratropium). This is because there are no 'asthmatic features/features suggesting steroid responsiveness'.
10005281
a
Combined long-acting beta 2 agonist and long-acting muscarinic antagonist
QuestionChoice
This may be considered following a trial of a combined long-acting beta 2 agonist and long-acting muscarinic antagonist if the person still has one severe or two moderate exacerbations within a year.
10005284
d
Combined long-acting beta 2 agonist, long-acting muscarinic antagonist and inhaled corticosteroid
QuestionChoice
According to the relevant 2018 NICE guideline, this should be combined with a long-acting beta 2 agonist (such as salmeterol) for optimum control.
10005283
c
Long-acting muscarinic antagonist
Concept
Chapter
2693
3717
Chronic obstructive pulmonary disease (COPD)
Topic
132
Respiratory
13603
A 65-year-old male is reviewed in the chronic obstructive pulmonary disease (COPD) clinic. He was diagnosed with COPD five years ago and is currently maintained on a salbutamol inhaler as required. He has recently started nicotine replacement therapy and stopped smoking. His latest FEV1 was 41% of predicted. Despite his current therapy he complains of frequent exacerbations. There is no history of asthma, eosinophilia or FEV1 variation.

Which of the following is the best next step in the management of this patient?
a