NAPLEX (North American Pharmacist Licensure Examination) Practice Exam

What is the next step in treatment escalation for COPD with the primary problem of dyspnea, after starting with LAMA or LABA?

1. LAMA + LABA

2. Switch inhaler only

3. Add SABA and SAMA

4. Start roflumilast

The correct answer is: LAMA + LABA

After starting with LAMA or LABA, the next step in treatment escalation for COPD with the primary problem of dyspnea would be to add a LAMA + LABA combination inhaler. This is because LAMA and LABA inhalers work differently to improve airflow and reduce symptoms of COPD. Combining them can provide a greater benefit than either medication alone. Switching to a different inhaler without adding the other type of medication may not effectively address the underlying problem of dyspnea. Adding SABA and SAMA inhalers may provide some relief of symptoms, but they are considered adjunctive therapies and are typically used as rescue medications rather than as a primary treatment for dyspnea. Starting roflumilast, a phosphodiesterase-4 inhibitor, would only be considered after other options have been tried and did not provide sufficient relief, as it carries a higher risk of side effects and requires close monitoring. Hence, the most appropriate next step in treatment escalation would be adding a LAMA + LABA combination inhaler.