A 58-year-old woman with COPD has been hospitalized three times for exacerbations. What change in her drug therapy is appropriate?

For a patient with chronic obstructive pulmonary disease (COPD) who has experienced multiple exacerbations, a change in therapy towards a combination product that includes a corticosteroid is particularly beneficial. The rationale behind this approach lies in the fact that corticosteroids are effective in managing inflammation in the airways, which can contribute to exacerbations in patients with COPD.

Combining a long-acting beta-agonist (like salmeterol) with an inhaled corticosteroid allows for both bronchodilation and reduction of inflammation. This strategy not only helps to improve lung function but also reduces the frequency of exacerbations and can lead to improved quality of life for the patient.

Additionally, corticosteroids can provide extra benefit during acute exacerbations and chronic management, making them an essential component of treatment for patients with more severe or frequently exacerbating COPD. In contrast, other options such as discontinuing existing medications or merely adding theophylline do not address the underlying inflammatory component as effectively. Thus, transitioning to a combination product that includes a corticosteroid aligns with guidelines for managing COPD with recurrent exacerbations.