In a patient with asthma and COPD on Relvar who has had two COPD exacerbations and a high CAT score, which COPD therapy would be most appropriate to use in place of Relvar?

• A. Montelukast
• B. Trelegy
• C. Fluticasone inhaler alone
• D. Ipratropium

Answer: (B)

When COPD remains poorly controlled on an ICS/LABA combination and there are frequent exacerbations, adding a long-acting muscarinic antagonist to create a triple therapy can reduce exacerbations and improve symptoms. Trelegy provides a single inhaler containing an ICS, a LABA, and a LAMA, addressing both ongoing airway inflammation and persistent bronchodilation. In this patient, who is already on Relvar (ICS/LABA) but has two COPD exacerbations and a high CAT score, switching to this triple therapy is the most effective way to improve control and reduce future exacerbations.

Montelukast isn’t a proven option for COPD management and won’t reliably reduce exacerbations. Using a fluticasone inhaler alone removes the LABA component, which is important for sustained bronchodilation in COPD. Ipratropium is a short-acting agent and does not provide the same long-term maintenance benefit or reduction in exacerbations as a LAMA-containing triple therapy.