Scribd
Upload
35 views1 page

Question 67 of 100: Explanation

A 64-year-old man with COPD is experiencing significant shortness of breath despite being on triple inhaled therapy and having elevated eosinophil levels. The most beneficial next intervention for him is mepolizumab, an anti-IL5 monoclonal antibody that reduces eosinophils and has shown to decrease COPD exacerbations in patients with elevated eosinophil counts. Other options like roflumilast, montelukast, prednisolone, and theophylline are less suitable for his condition.

Uploaded by

nomanaslam3003
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
35 views1 page

Question 67 of 100: Explanation

A 64-year-old man with COPD is experiencing significant shortness of breath despite being on triple inhaled therapy and having elevated eosinophil levels. The most beneficial next intervention for him is mepolizumab, an anti-IL5 monoclonal antibody that reduces eosinophils and has shown to decrease COPD exacerbations in patients with elevated eosinophil counts. Other options like roflumilast, montelukast, prednisolone, and theophylline are less suitable for his condition.

Uploaded by

nomanaslam3003
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Question 67 of 100 LOG OUT 

[Link]/[Link]

A 64-year-old man with chronic obstructive pulmonary disease (COPD) is reviewed in the Respiratory Clinic Difficulty: Average
after a third exacerbation in the past year. He has stopped smoking five years earlier. When he was first
diagnosed, he showed some reversibility after a trial of oral prednisolone. He is currently managed with triple Peer Responses %
inhaled therapy but is still markedly short of breath and finds it difficult to walk 200 m to the bus stop. His
blood pressure is 123/82 mmHg, and his heart rate is 67 bpm and regular. His chest is hyperexpanded and he
has a quiet wheeze on auscultation.

Investigations:

Investigation Result Normal value

Haemoglobin (Hb) 139 g/l 115–155 g/l

White cell count (WCC) 7.3 × 10 9/l 4–11 × 10 9/l

Eosinophils 0.6 ×10 9/l 0.02–0.5 ×10 9/l


Q. Answered Flagged
Platelets (PLT) 192 × 10 9/l 150–400 × 10 9/l
Q1
Sodium (Na +) 142 mmol/l 135–145 mmol/l
Q2
Potassium (K +) 3.7 mmol/l 3.5–5.0 mmol/l
Q3
Creatinine (Cr) 95 µmol/l 50–120 µmol/l
Q4
Forced expiratory volume in one second (FEV1) 50% of predicted
Q5
Forced vital capacity (FVC) 82% of predicted
Q6
What is the most useful next intervention?
Q7

Your answer was incorrect


Q8

Q9 
A Mepolizumab

B Montelukast  External Links

NEJM- Mepolizumab for Eosinophil…


C Prednisolone [Link]/doi/full/10.1056/nejmoa17082…

D Roflumilast

E Theophylline Chronic Obstructive Pulmonary Disease

Explanation 

A Mepolizumab
Media Expanded Flashcards
explanations
Mepolizumab is an anti-interleukin 5 (IL5) monoclonal antibody that depletes eosinophils. This patient’s
chronic obstructive pulmonary disease (COPD) is a special case that is expected to benefit from eosinophil
depletion, given that he has an elevated eosinophil count and a reversible component to his airway obstruction.
The mepolizumab phase 3 study showed that in patients with elevated eosinophil counts, mepolizumab is
associated with an 18% reduction in moderate or severe COPD exacerbations, compared to no significant
impact across the patient population as a whole.

D Roflumilast

Roflumilast is a phosphodiesterase type 4 (PDE4) inhibitor, useful in patients with COPD that is not controlled
on triple inhaled therapy. However, here an anti-eosinophil agent is preferred, given the reversibility and
elevated eosinophil count.

B Montelukast

Montelukast is a leukotriene receptor antagonist. It is most useful in the management of uncontrolled asthma.
It does not have a role in the treatment of COPD.

C Prednisolone

Oral steroids are not preferred in the long-term management of COPD because of the negative impact on
weight, glucose tolerance and bone mineral density.

E Theophylline

Theophylline tablets have limited impact on patients with COPD who are already treated with adequate beta-
agonist therapy. They also increase the risk of atrial fibrillation.
73197

Rate this question:

Next Question

Previous Question Tag Question Feedback End Review

Blog About Pastest Contact Us Help

© Pastest 2024

You might also like